Dolpa, Nepal’s largest district by area, is known for its breathtaking Himalayan landscapes, remote villages, and strong cultural traditions. It is also one of the most geographically challenging areas in the country, making access to maternal healthcare a complex and often dangerous journey.

For years, One Heart Worldwide has worked to change this reality by upgrading health posts, training providers, and improving access to quality maternal and newborn care in Dolpa. While our work initially led to an exit from the district after local needs were addressed, we re-entered Dolpa in 2022 following a reevaluation of those local needs in partnership with the local government and communities. This year, we are once again preparing to exit the district, having helped re-strengthen local systems and infrastructure.

The latest result of this renewed effort is the construction of a new Maternity Waiting Home in Dunai, completed in December 2024.

Located near Dolpa District Hospital, the Maternity Waiting Home offers a safe and dignified space for pregnant women who travel long distances to access care. The facility was made possible through the collaboration of One Heart Worldwide, the Health Service Office, the District Hospital Construction Committee, and our implementing partner in Dolpa, the Women Empowerment Center. 

The Maternity Waiting Home includes two bedrooms, a kitchen, a toilet and bathroom, a storeroom, and a heating system to keep mothers warm in Dolpa’s cold climate. It was designed to meet the needs of pregnant women who face financial and cultural barriers to finding accommodation near the hospital.

Community Voices from the Field

Rana Bahadur Karki, Project Advisor of the Women Empowerment Center, shared:

“The Maternity Waiting Home has provided a shelter for the pregnant mother, who can’t afford the hotel costs for their accommodation while traveling to District Hospital, Dunai, Dolpa, for their newborn baby delivery. There, they can stay the night in a comfortable bed with a warm quilt covering. They can also cook their food by bringing the ingredients to use in the equipped kitchen of the Maternity Waiting Home. Before, when they couldn’t afford the hotels, the pregnant mother and their family had to stay in herds while traveling to District Hospital for treatment due to cultural and religious beliefs and rituals of cleanliness when a baby is born. Obtaining an accommodation reservation is extremely challenging in Dolpa.

The Maternity Waiting Home is very crucial. The locals and district officials are very happy with the construction of a beautiful and well-equipped Maternity Waiting Home. The locals have arranged to draft the Code of Conduct for the proper use and maintenance of the MWH, and certain security deposits will be taken from the service receiver and a focal person is assigned to take care of and manage the MWH.”

Kamal Bahadur Shahi, Chairperson of the Hospital Development Committee, added:

“Why is Maternity Waiting Home essential? The District Hospital, one of the health facilities, is located a considerable distance away, and it’s challenging to seek shelter and accommodation for 10–15 days for medical maternity services due to untouchability and cultural and ritual beliefs after delivery. The Maternity Waiting Home is crucial for remote mothers who are not economically well-off.

I am very pleased to share that the Maternity Waiting Home in Dolpa has been constructed, and I am proud to have led the team in its construction. I appreciate the support and effort from all parties involved in its construction. As a result of this construction, more beneficiaries can now seek medical care and services from the nearby Dolpa District Hospital.

Further, we have worked to budget forecast to Karnali Provincial Government for the budgeting in the sector of maternal and neonatal health.”

Dr. Akhanda Upadhaya, Medical Officer at Dolpa District Hospital, explained:

“It’s difficult to rent the room for accommodation nearby to the District Hospital, due to the cultural belief to clean the house and rooms through rituals and sacrifice a goat, which is costly for the family of pregnant mothers. The idea and plan for constructing the Maternity Waiting Home were initiated in 2022. Palika funding wasn’t sufficient; it was initiated to seek funding from the Provincial government, as well as some from the Hospital Development Committee, and primarily from One Heart Worldwide. In December 2024, construction was completed, with service delivery and operationalization currently underway. I would like to express my gratitude to One Heart Worldwide, Women Empowerment Center, Health Service, and Hospital Development Committee for the support and contribution to build the facilities as most needed in Dolpa.”

As of early 2025, two mothers have already utilized the Maternity Waiting Home and delivered their babies safely, with an average stay of five days. As more women become aware of the facility, it is expected to serve many more in the months ahead.

This project is another example of how community-driven partnerships can bridge the gap between remote geography and life-saving care. One Heart Worldwide remains committed to supporting health systems until they are self-sustaining and able to serve every mother and newborn with dignity and safety.

Dr. Usha Jha, Nepal Advisory Board Member, One Heart Worldwide

With decades of work helping to uplift Nepali women belonging to marginalized communities, Dr. Usha Jha has been a passionate advocate for women’s economic empowerment through action-oriented savings and literacy, particularly in rural Madhesh and mid-hill areas. Although she considers herself more fortunate than a lot of women from her Madheshi community, she has witnessed the challenges faced by women in both her home and across the country. 

Her journey has been transformative, leading her success to prominent positions demonstrating her professional growth. Very recently, she completed three and half years of tenure at the National Planning Commission, and this opportunity, above all, has given her exposure to inclusive development from the apex governance structure. One Heart Worldwide team is proud to have Dr. Jha join Nepal's Advisory Board as one of its members.

Dr. Jha’s connection to the Madhesi community runs deep. Born in India, she is married into a family from Mahottari, a district in Nepal’s southern plains, where patriarchal traditions still hold sway. “The socio-cultural and the economic barriers, especially for women, in our community are significant,” she explains. “Women are mostly left behind, unable to participate in the local processes, and have little to no access to resources.”

A Defining Moment: Resistance in Morang

Dr. Jha’s professional journey, unlike that of many Madheshi women, wasn’t marked by significant personal barriers. However, her mission to advance women’s economic empowerment came with its own challenges. One of the most profound experiences of her career took place during the early days of implementing a Women’s Empowerment Program in Morang, a district in southeastern Nepal.

Tasked with organizing women from the fishing community into savings groups, Dr. Jha encountered an unexpected obstacle—resistance from the men in the village.

“As I was entering the village, a man approached me and said, ‘Why are you coming to my village? Our women are good, our families are good. If you come, our women will be spoiled. Don’t spoil our women,’” Dr. Jha recalls.

The man, visibly intoxicated, adamantly refused to let her proceed. “It was so difficult to convince him,” Dr. Jha recalls. “He didn’t allow me to enter the village, so I turned back without forcing the issue.” 

Undeterred, Dr. Jha spent the following days in Biratnagar, reflecting on alternative approaches to reach the community. She soon decided to engage the local schoolgirls, working with them to design a grassroots strategy.

“I met with some of the girls from the village who were attending school, and together, we developed an action plan to introduce women’s savings groups and solidarity initiatives—without my direct presence in the village,” she explains.

This peer-education model allowed the program to grow organically, with the women taking ownership of their economic empowerment. Through their savings groups, they not only gained access to financial resources but also earned recognition within their families and the community. The women became both savers and borrowers, channeling interest and group activities—like singing, dancing, and small enterprises—back into their initiatives. Over time, some women even created employment opportunities for men in the community.

Five years later, when Dr. Jha returned to the village, the transformation was striking. The same man who had initially turned her away welcomed her warmly.

“He cleaned the floor, set out a chair, and said, ‘You’ve done such a good thing. My wife now has access to money, and she even supports me financially when I need it,’” she recalls with a smile.

For Dr. Jha, this moment underscored the power of community-driven change. “That experience reinforced my belief that the best way to enter a community is through its own people. Empowering women through local networks is the key to sustainable transformation.”

Economic Empowerment & Social Change

Dr. Jha’s work with Samjhauta Nepal, an all-women NGO she helped establish, exemplified her belief in the power of grassroots movements. She inspired a large number of women to be organized and helped set up savings groups and entrepreneurship initiatives. Through her NGO, she helped them be in charge of both their finances and lives. “It was challenging at first to convince the women to come out of their homes. However, we persevered by educating the women about being economically empowered and working together in solidarity. They found new courage and started coming out,” Dr. Jha fondly remembers.

This approach, she explains, was not just about improving livelihoods but also about fostering a sense of ownership and community. “When women save their own money and make decisions together, they learn not just financial literacy but also leadership. They start to see themselves as agents of change.”

The initiatives by Dr. Jha and her team at Samjhauta Nepal have helped to benefit 125,000 women across 21 districts, empowering them to build stronger communities. “The only way for women to empower themselves is by being economically independent,” she says. “And that starts with creating opportunities for them to generate and manage their own income.”

Dr. Jha believes that good partnership within families is also important. “My husband has been a great support to my work, and he also strongly believes in the importance of empowering women,” she shares. This support allowed her to pursue her professional and academic journeys, followed by taking on leadership roles without the cultural restrictions that many women in the Madhesh face. 

Joining One Heart Worldwide: A Passion for Maternal & Neonatal Health

As a Nepal Advisory Board member of One Heart Worldwide, she deeply connects to maternal and newborn healthcare. “I had heard about their incredible work in the field, and it resonated deeply with my own passion for supporting mothers,” she shares. 

At the national level, Dr. Jha has played a crucial role in developing strategies for early childhood development and multi-sector nutrition plans. “To me, that’s where the whole world starts—by supporting women during pregnancy, six months before conception, and after,” she explains.

She is particularly concerned about integrating marginalized women into the healthcare system, especially those in Madhesh. Although the Ministry of Health has a network of family community health volunteers, the connection between women and the healthcare system still falls short. “One Heart Worldwide needs to fill where the gaps are so that women can happily come to the health post to get the proper services.”

Prioritizing and addressing the barriers these women face is crucial.  “Especially in Madhesh, they face so many socio-cultural and economic constraints. Pregnant women are often shy and hesitant to come forward,” she observes. For Dr. Jha, the solution lies in advocacy, awareness, and outreach: “Some level of advocacy, some level of training, and some level of awareness programs need to happen. Women need to feel confident enough to visit the health post.”

A journey of empowerment

As Dr. Jha looks back on her life, she feels proud of the many women she has worked with who have transformed into leaders. “When I go to meetings now, I see women who were once my social mobilizers now sitting as the members of Parliament. That, for me, is the greatest achievement,” she reflects.

Her journey, from struggling to learn the Nepali language to leading national and international initiatives for women’s empowerment, is an example of how education makes a difference. “I’ve learned that women are incredibly powerful—they just need the opportunity to show it.”

For young Madheshi women aspiring to entrepreneurship and leadership, Dr. Jha offers this advice: “Don’t leave any opportunity to educate yourself. Stay engaged with what’s happening around you. And always remember that your attitude and commitment will shape your future.”

2010: A Dangerous Journey into Motherhood

In 2010, giving birth in Nepal, particularly in remote regions like Baglung and Dolpa, was fraught with risk. For the majority of women, childbirth took place at home without the support of a trained medical professional. Nationally, only 20% of women delivered with a skilled birth attendant (SBA). In Baglung, that number was less than 19%, and in Dolpa, it was less than 5%. Maternal and neonatal mortality rates in northwestern Nepal were five times the national average.

Facilities and trained professionals were scarce. Many birthing centers lacked essential equipment, and the nearest hospital might be days away by foot. Cultural taboos, financial constraints, and inadequate infrastructure made it nearly impossible for women to access even basic prenatal care. For too many families, the joy of childbirth was overshadowed by grief.

This was the landscape when One Heart Worldwide (OHW) began its work, committed to addressing the barriers to safe motherhood and childhood. In partnership with local organizations like SWAN in Baglung and Dharma Karma in Dolpa, OHW introduced life-saving interventions, including training programs for Female Community Health Volunteers (FCHVs) and equipping birthing centers. By 2011, Hatiya and Paiyunpata Birthing Centers in Baglung and the Dunai Birthing Center in Dolpa were fully operational, providing critical support to their communities.

The impact was immediate and profound. By the end of 2011, the percentage of women delivering with an SBA in OHW program areas soared to 70%. Similarly, OHW programs saw maternal deaths drop to zero among the 237 births recorded in 2011 and neonatal deaths were reduced to just two. The percentage of women attending at least three prenatal visits surpassed 95%, setting a new standard for maternal healthcare in these regions.

2024: A Revolution in Maternal Care

Fast-forward to 2024, and the story of childbirth in Nepal has transformed dramatically. Over the past 14 years, OHW’s programs have reached over 1.3 million mothers and newborns.

The cumulative numbers as of the end of 2023 tell a compelling story:

• Improved access to quality maternal and newborn care for 22% of Nepal’s pregnant women and infants.

• 721 birthing centers upgraded, including 81 new upgrades in 2023 alone.

• 770 Skilled Birth Attendants trained, with 76 completing their training last year.

• Introduction of cutting-edge rural obstetric ultrasound training for SBAs, with 28 participants in 2023.

These efforts have driven a 48% average increase in births attended by trained healthcare providers in transition districts. In 2023 alone, OHW’s programs benefited 277,241 mothers and newborns, setting a new benchmark for maternal and neonatal care in Nepal.

Today, families can access well-equipped birthing centers within their communities. These birthing centers are supported by skilled SBAs trained in delivery and the use of tools like portable, rural ultrasounds. Additionally, FCHVs continue to play a crucial role on the ground, providing essential education and outreach to ensure that every woman feels empowered to seek care before, during, and after childbirth.

OHW’s Path Forward

The real story of One Heart is the power of partnerships, local engagement, and focusing on access to quality care. The past 14 years are evidence that we can create real, material change for women and newborns across Nepal by investing in a comprehensive safety net that invests in their community and considers their cultural and geographical realities. 

OHW’s efforts have saved countless lives, but our mission is far from over. Our next milestone is to triple our impact by 2028 to reach 3.8 million mothers and newborns with improved access to quality maternal and newborn care. In other words, we are doubling down on our commitment to make childbirth safe for every woman, no matter where she lives.

Looking back on OHW’s work, one thing is clear: Nepal's maternal and newborn health story is no longer one of despair but of hope, resilience, and transformation.

Here are some easy ways to get involved:

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The Journey of Dr. Anil Shrestha, Nepal Advisory Board Member

By Naresh Newar

A Father's Dream, A Son's Calling 

Dr. Anil Shrestha muses that his journey to medicine was written in the stars well before he was born. His father aspired to become a doctor, but his dream was unfulfilled. "My father went to get admission in medical school in Patna, India, but couldn’t get through," Dr. Shrestha recalls. "It became his mission that one of us—his sons, nephews, or nieces—would don that white coat." That dream fell upon Anil, the youngest son, who enthusiastically embraced it. He enrolled at Calcutta Medical College, diving into the world of medicine that would one day shape not just his life but also the healthcare landscape in Nepal. 

Freshly graduated, Dr. Shrestha hoped for a comfortable post in his hometown, Kathmandu. Instead, he was assigned to Jumla, one of Nepal’s most remote and underdeveloped regions. “I said, ‘For me, anywhere outside Kathmandu is remote,’” he laughs. But that journey to Jumla would prove transformative. "It was an eye-opener. I had no idea what rural Nepal was really like. When I reached Jumla, I asked myself, ‘Why do we become doctors?’ It’s because we have to make a difference." 

Beyond the X-ray: treating a whole patient 

The moment that would forever shape his approach to medicine happened at a government-run medical camp. An injured man had journeyed from a remote village all the way to Kathmandu for surgery, selling his land to pay for it. He needed to remove his implants but faced the grim reality of having to sell more of his land to afford the procedure. "I thought to myself, ‘We treat the X-rays, but we don’t treat the patients.’ What good is a perfectly functioning hand if this man could no longer have a land to plow?" That encounter made him think that healthcare should look beyond the symptoms and the diagnoses and consider the socio-economic realities of patients. 

From then on, Dr. Shrestha made it his mission to provide care that didn’t just fix bodies but also addressed the underlying factors affecting people’s lives. This became the foundation of his life's work and the seed from which the Nepal Orthopedic Hospital would grow. 

Building Hospitals Out of Dreams 

After co-founding the Nepal Orthopedic Hospital in the 1990s, Dr. Shrestha’s career as a surgeon also evolved into becoming a social health entrepreneur. His vision was simple but bold: a hospital that could provide high-quality orthopedic care at affordable prices. But what he found when he arrived at the site was anything but promising. "It was just two blocks of a one-story building," he recalls. "They said, ‘Here’s the hospital. Run it.’ But buildings don’t make hospitals. You need doctors, you need equipment, you need patients." 

Conceiving a bold plan and garnering the support of friends and international donors, Dr. Shrestha started with 15 beds, providing care to anyone in need, regardless of their ability to pay. "My goal was to make our hospital self-reliant and make it sustainable. Initially, 93% of our operating expenses were covered by international donors. In less than ten years, it was the reverse. About 93% came from internal revenue." Today, it is self-sufficient, and its mission remains unchanged: nobody will be refused care because of inability to pay. Over the past 25 years, it has given more than $1 million in charity care. 

His job was far from over. Realizing how desperate the need for spinal care was in Nepal, Dr. Shrestha co-founded the Spinal Injury Rehabilitation Center in 2001, offering holistic treatment to paraplegic and quadriplegic patients. It was a leap of faith that started with a few friends, a handful of nurses, and no specialized doctors. "We just knew the need," Dr. Shrestha says, “and thought, why wait? You start small, and if you’re doing well, others will help you." 

A New Chapter: Collaborating with One Heart Worldwide 

After years of building hospitals from scratch, Dr. Shrestha’s journey took another turn when he was asked to join the Advisory Board of One Heart Worldwide, whose mission—to reduce maternal and neonatal mortality in Nepal’s most underserved areas—deeply resonated with him. He had long believed that healthcare in Nepal needed to reach the farthest corners and OHW’s model of working with local governments to deliver comprehensive care aligned with his own philosophy on healthcare. 

"I used to think, like many, that the government didn’t do anything. That we had to step in where they failed," Dr. Shrestha admits. "But after my work with Nick Simons Institute, I realized that by working with the Government, we could achieve four, five times more. That’s exactly what One Heart is doing—working to strengthen the health system, not parallel to it." 

As a Board Member, Dr. Shrestha continues to guide One Heart in an advisory role and looks forward to contributing to its future projects. He is particularly proud of their district-focused Network of Safety model, which emphasizes deep, sustained engagement over six years, ensuring long-term impact rather than short-term fixes. 

Leadership Rooted in Humility and Trust 

Dr. Shrestha’s approach to leadership is as grounded as his approach to medicine. He never studied leadership in a classroom; instead, he learned by experience. "Humility is key. I don’t know if it works for all Nepalis. But it helped me," says Dr. Shrestha. He stays close to the people–doctors, nurses, even cleaners. “This,” he says, “fosters a sense of unity and trust that's essential in difficult times.”

He recalls a time at the Orthopedic Hospital when funds were so tight that salaries couldn’t be paid. "I was transparent about it," he says. "We didn’t hide anything. And the staff worked without pay for two or three months. That’s the kind of trust we had." His leadership was never about control; it was always about enabler-ship. After a decade at the hospital,  Shrestha stepped down as Medical Director after ten years, knowing that the institution would continue to do very well without him. After stepping down, he stayed at the hospital for eight more years to work as an Orthopedic Surgeon and eventually moved on to join the Nick Simons Institute.

Dreaming Big for Nepal’s Healthcare Future 

Dr. Shrestha has a vision to open centers for spinal rehabilitation across all seven provinces of Nepal to give specialized care to the most in need. But more than that, he wants a health system where each district's hospital is adequately equipped and functional, thereby discouraging the movement of patients to Kathmandu for even the simplest of medical services. "If we focus on these 77 district hospitals," he says, "we really can change the face of healthcare in Nepal." 

His message to the next generation of Nepali doctors and social entrepreneurs is: "You don't have to wait until everything is perfect to get started. All you need is an idea, and if you see a need, jump into it." He adds, "Start small, and you will always have people to help if you’re passionate and clear about your goals." 

A team effort: Not one person's achievement 

Dr. Shrestha's story is one of quiet determination. He is not a man seeking the limelight. On the contrary, he avoids it. He is quick to credit others for his achievements–his team, his donors, his partners."When you build an institution, don’t think it’s yours," he says. "It belongs to everyone who helped along the way." And yet, it’s impossible to ignore his profound impact on Nepal’s healthcare system. 

Through his work at the Orthopedic Hospital, the Spinal Rehab Center, Nick Simons Institute, and now One Heart Worldwide, Dr. Anil Shrestha has been a healthcare leader and contributed to efforts that have saved and will continue to save innumerable lives. He has equally inspired a new generation to look beyond profit toward purpose. Dr. Shrestha’s legacy does not stop at the institutions he founded but extends to the idea that healthcare is caring for the whole person: mind, body, and soul. 

Due to continuous heavy rainfall from September 27 - 29, 2024, many people have been severely affected, particularly in the Bagmati and Madhesh provinces. These regions have experienced significant flooding and landslides. Although the government and non-governmental organizations are responding to the crisis, the support provided so far is insufficient given the scale of the disaster. The needs are vast across all affected areas, and we are currently working to identify the most impacted individuals in our focus regions, particularly in Bagmati and Madhesh provinces. These are districts where One Heart Worldwide has been working: we have completed our program in Kavrepalanchok in 2023, are transitioning in Sarlahi, and are actively implementing programs in Rautahat.

Sarlahi District from Madhesh province:

According to the District Disaster Management Committee (DDMC), the Maternal and Child Health (MCH) Cluster Meeting, and various media reports, 1,670 households have been affected by the recent flooding in the district, impacting 22,307 people. Of these, 477 households have been completely displaced. Among the affected population, 1,672 pregnant and recently delivered women have also been impacted. Tragically, three deaths have been reported. Many homes remain flooded, making it extremely difficult for residents to stay inside (as per the DDMC/MCH Cluster Meeting).

According to information from health workers in the affected communities, pregnant women, recently delivered women, children, and elderly individuals have been severely impacted by the flooding. Many people have been displaced and are forced to live in the open without proper shelter. While Maternal and Newborn Health (MNH) services continue at local health facilities, access has become difficult due to the displacement of the population. Three health facilities in the district were affected by the flood but have resumed services after the rains stopped.

The District Disaster Management Committee (DDMC) has urged both government and non-governmental organizations working in the district to coordinate with them to provide food and non-food items to the flood-affected population. In close collaboration with local partners, including RRPK, BWSN, and Save the Children, the DDMC has distributed food aid to affected families, targeting 100 households in Dhankaul Rural Municipality and 100 households in Balra Municipality.

Local governments and the health office have also planned to set up temporary health service points and deploy health workers to visit households to assess the health conditions of affected individuals.

Rautahat District from Madhesh province:

The overflow of the Bagmati and Lalbakaiya rivers has caused widespread flooding across the Rautahat district. According to an initial emergency rapid surveillance report, the flood has affected 17 out of 18 municipalities in Rautahat, either completely or partially. Thanks to the early warning systems and information shared via social media, many people were aware of the impending disaster and managed to reduce its impact. Despite these efforts, two people lost their lives, six were injured, and 45 houses were destroyed, while 130 were partially affected. Additionally, 1,890 households have been displaced, resulting in the displacement of 5,595 individuals, according to a bulletin released by the District Administrative Office of Rautahat.

A District Disaster Management Committee (DDMC) meeting was held on October 1, 2024, chaired by Mr. Hiralal Regmi, the Chief District Officer, to assess the damage and outline necessary steps for immediate response, long-term recovery, and preventive efforts. The meeting was attended by local government officials, district-level stakeholders, and representatives from INGOs, NGOs, and the private sector. It was decided that each local government (Palika) would receive an immediate allocation of Rs. 2,00,000 (Two Lakh) to support relief efforts for those affected by the flood.

According to the latest bulletin, only Oxfam and RDC have distributed relief supplies to 850 households in Durgabhagwati Rural Municipality. The aid included essential food items such as rice, lentils (dal), sugar, salt, oil, clothing, and ready-to-eat items like beaten rice, dalmoth, and biscuits.

Additionally, 11 health posts have been affected by the flooding. However, no significant damage has been reported, as confirmed by communication with the respective health facility and Palika coordinators.

Kavrepalanchok District from Bagmati province:

Nine health facilities were severely impacted by floods and landslides, five of which were fully damaged and four partially damaged. They requested OHW for the Medical tents, medical equipment, supplies, medicine, and furniture for continuing health services at damaged health facilities and relief materials (shelter, food, cloth, and hygiene), especially for pregnant and recently delivered women. According to news in the media so many people, and communities were displaced because of the landslide, however, currently, we are not physically present at Kavrepalanchowk. In this condition, we may not be able to find out the real affected people so we are planning to support a fully damaged health facility to resume their regular services from health facilities ie primary care focusing on prevention, promotion, and first aid treatment.

One Heart Worldwide’s Emergency Response

One Heart Worldwide has received requests for support from the districts of Rautahat, Sarlahi, and Kavre due to the recent flooding. The requested items include dignity kits, winterization kits, tents, kitchen items, food items, and medical tents with equipment and supplies.

OHW’s immediate response focuses on delivering dignity kits to Rautahat and Sarlahi, along with tents and food items to both districts. Additionally, we are setting up birthing tents in Kavre, ensuring safe deliveries and critical care for pregnant women and new mothers. Each birthing tent is fully equipped with essential medical supplies to support safe childbirth in these affected areas. OHW remains committed to supporting the most vulnerable populations in all three districts during this emergency.

In Maidi village of Jwalamukhi Rural Municipality, Dhading District, Pradeep’s face radiates with joy as he cradles his newborn son. His wife, Amrita, had just given birth at the Maidi Health Post, a facility that has transformed its modestly equipped birthing center into a model of excellence. This transformation was made possible through the combined efforts of One Heart Worldwide (OHW) and the local government of Jwalamukhi when OHW implemented the Network of Safety from 2015 to 2021.

Amrita and her family are among the many who have benefited from OHW’s Network of Safety model in Dhading. By 2018, after four years of work, OHW successfully handed over the program to the local governments in the district’s 13 municipalities, ensuring continued progress and care for the community. 

“We are so thankful we came here,” Pradeep said, his eyes focused on his baby and shining with gratitude. “The maternity home helped us give our baby a safe and healthy start in life.”

The maternity home, constructed with OHW’s support, provided a comfortable and safe space for expectant and recently delivered mothers to stay before and after giving birth. Amrita had traveled from her Ratomata village, driving on the rough roads for two hours in a for-hire off-road vehicle to reach the health post. 

She was thrilled with the care she received. “I feel so relaxed staying in the maternity home,” she said. “The nurses are very helpful; we get free food and ambulance service. It’s a really comfortable place.”

The effectiveness of the maternity home at Maidi Health Facility encouraged the local government to create more maternity homes in more health facilities in Jwalamukhi Rural Municipality.

Sangita, a Female Community Health Volunteer (FCHV), has seen firsthand the transformation in her community. “Before, we used to tell women to visit health facilities, but they were shy and hesitant,” she said. “Now, pregnant women and their families visit my house for advice. They are more interested in getting information to ensure safe pregnancy and childbirth.”

As an FCHV, Sangita’s role is crucial in educating women about safe motherhood and tracking pregnancies in the community. She has been trained by OHW to provide counseling on birth preparedness, recognize danger signs, and refer women to health facilities. “We work very closely with communities,” she said. “OHW has done a very good job. Projects come and go, but we should all play a role in giving continuity to such initiatives.”

Sustaining the Continuum of Quality Care

Sujan Shrestha, Health Coordinator of Jwalamukhi Rural Municipality, has witnessed the transformation of MNH care in his municipality and despite the departure of OHW from Dhading, the continuum of quality care has remained consistent. 

“We have been providing proper support, sustaining quality services to women. We have consistently made plans in a strategic way to ensure safe pregnancy and safe motherhood,” says Shrestha.

The rural municipality has also taken steps to ensure the sustainability of the program. “We have 40 female community health volunteers (FCHV) and we mobilize them actively in the community where they can track and identify women with pregnancies, educating them about pregnancy care and the number of visits they should make at the health facilities,” Sujan said.

He shares how the impact of the Network of Safety is evident in the data – zero maternal deaths in the past three years in the municipality, and a significant reduction in neonatal deaths. But it was not just the numbers that told the story – it was the lives of women and children that had been transformed forever, explains Shrestha, and this is not just limited to his municipality but extends to the rest of the district.

OHW’s strategic approach of prioritizing partnerships with municipal governments has been central to the program’s sustainability. Local bodies have taken ownership of the program activities, including budgeting for the ultrasound program and purchasing emergency medicine. Many health facilities are actively working on the Zero Home Delivery program, aiming to eliminate home births in favor of safer, facility-based deliveries.

“the Impact of the Network of Safety is evident in the data – zero maternal deaths in the past three years in the municipality, and a significant reduction in neonatal deaths.”

- Sujan Shrestha, Health Coordinator of Jwalamukhi Rural Municipality

A Lasting Impact

The story of Maidi village, Jwalamukhi Rural Municipality, and the broader Dhading District exemplifies the profound impact that strategic partnerships and community engagement can have on maternal and newborn health. Through the collaborative efforts of One Heart Worldwide and the local government, the Network of Safety has not only transformed health facilities but also instilled a sense of ownership and responsibility within the community. The sustained progress in maternal and neonatal care, evidenced by improved health outcomes and the establishment of critical resources like upgraded birthing centers, highlights the importance of continued commitment to these initiatives. 

As OHW transitioned out of Dhading District in 2021, the strong foundation it established has continued to flourish under the stewardship of local communities and government. Now, three years later, the vision of safe motherhood remains vibrant, offering hope and a brighter future for countless families in Dhading and beyond.

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By Naresh Newar in Mahottari, Nepal

Kiran Kumari Thakur understands the barriers to convincing women to seek appropriate maternal care all too well. As a female community health volunteer (FCHV), she has the challenging job of educating families about safe motherhood practices, often facing resistance from older women set in their traditional ways. 

“Changing behaviors is very difficult, especially with the matriarchs who control the younger women in the household,” Kiran explains. “When I visit pregnant women to discuss safe pregnancy and delivery, I often get scolded for ‘distracting’ the daughters-in-law from their chores.”

“But I never give up, and it is my duty to meet every pregnant woman to ensure they get all the information for safe deliveries at health facilities,” says Kiran, one of the new generation of FCHVs in Pipara Rural Municipality of Mahottari district. Mahottari is one of One Heart Worldwide’s new program districts in Madhesh Province, which experiences one of the highest maternal mortality ratios in Nepal.

Empowering FCHVs with OHW’s support

Pipara is one of the 15 municipalities where OHW and our local NGO partner Ratauli Yuwa Club (RYC) have been working closely with local governments to establish a high-quality MNH system since 2023.

With training from OHW and RYC, Kiran and other volunteers have new tools to empower communities. They learn how to educate about birth preparedness, danger signs in labor, and preventing life-threatening complications. They also educate and motivate women about the importance of antenatal (ANC) and postnatal care (PNC) visits at local health facilities.

“There have been many positive changes, and we are working hard to change the traditional mindset and old social norms at both community and household levels,” says Kiran. One key initiative by OHW and RYC is to organize regular Health Mothers’ Group meetings, where mothers-in-law and other household members are also invited to learn about MNH issues.

OHW and RYC held community perception assessments during the program’s first implementation stage. They were shocked to find little awareness about ANC and PNC, a preference for home birth delivery, failure to recognize danger signs during and after pregnancy, a lack of importance given to iron tablets, and no knowledge about the importance of postpartum care at home or proper nutrition for mothers.

“These are issues that we had been raising with families long before OHW and RYC started its program in our municipalities. But now, we have learned how to educate them better. Their guidance has made us more professional,” says Rita Pandey, a senior FCHV in Ekdara Rural Municipality, where she has been working for several decades.

“We have learned so much about educating women through the Birth Preparedness Package (BPP) training. Through the training provided by OHW and the Government, we are able to use visual materials that help to explain safe motherhood practices more clearly and accurately to the families,” says Rita. She explains how the Health Mothers’ Group meetings have been reactivated and held regularly, unlike before when these meetings were irregular and did not have high participation from pregnant women, mothers, or their family members.

Shortage of nurses

One of the most critical concerns in Mahottari is the scarcity of nurses. “I try my best to give 24-hour service, and despite the huge flow of patients, I provide service to everyone,” says Babita Kumari Mandal, an Auxiliary Nurse Midwife (ANM). She is the only nurse at Ekdara Health Post and often has no time to leave due to the volume of patients she sees.

“I am so happy that we have a nurse like her. If I have any complications, I can visit her anytime, even at night. I feel safe because of her,” says Priyanka Yadav, a young expecting mother. We met her during her eighth and final ANC checkup. She shares that many women in her neighborhood, like her, are lucky as the health facility is very close to their homes, and they have a trained nurse like Babita close by.

Even within Ekdara Municipality, we found that different wards had both poor and high-quality health facilities. Not every woman was as lucky as Priyanka and her neighbors. 

“It is especially challenging for women from families with limited resources. They can’t afford to travel to the cities. In their wards, they make the effort to visit the health facility and realize that there are not enough facilities for blood and urine tests, or there are no ultrasound machines,” says Ibrahim Nadaf, Health Sub-Coordinator of Ekdara Municipality.

He adds that even when municipalities want to upgrade their health facilities, they are under-resourced, and this is where OHW’s support is imperative.

However, Ekdara’s Deputy Mayor, Mahajabi Khatun, is positive that the situation for women’s health is improving compared to the past. She shares, “I remember coming to this municipality as a young bride, and most women were not aware of safe motherhood. But their attitudes and behaviors are changing.”

The awareness programs have helped provide women with new knowledge and information.

“We are thankful for the support from OHW and RYC; they have already been helping to educate many women and FCHVs. We are hopeful they will continue supporting us,” says Deputy Mayor Khatun.

By Naresh Newar and Niraj Bhattarai

Niraj Bhattarai is the Program Coordinator of Dalit Development Society, an OHW partner organization in Salyan District.

Niraj’s dedication to enhancing the well-being of vulnerable communities, particularly mothers and newborns, has been an integral part of his life. “Through my experiences, I developed a deep connection with pregnant women and neonates in the most rural and unreached areas,” he reflects.

Educated with a Public Health degree, Niraj started his journey as a training officer with Max Pro in Dhading district. In the rural part of upper Dhading, Niraj helped build the knowledge of health workers by providing them with training on Infant and Young Child Feeding (IYCF).

After his time in Dhading, Niraj’s journey took him to Baglung district, where he joined Medic Mobile as a Senior Training officer. There, he focused on equipping health workers and Female Community Health Volunteers (FCHVs) with new skills to leverage mobile technology for maternal and neonatal health. His work in Baglung contributed significantly to scaling up life-saving interventions and strengthening the healthcare system in the region.

These experiences in rural areas deepened Niraj’s empathy for pregnant women and newborns, driving him to further his work with the Suaahara program. For two years, he was involved in enhancing the nutritional well-being of expectant and lactating mothers, as well as young children under two years old, in Bajura district in Sudurpaschim (Far-West) Province.

“The health status of pregnant adolescents and children was really poor in the district,” he remembered. In June 2022, a report by the leading Nepali newspaper (Kantipur) revealed that nearly 200 pregnant and adolescent girls in Swamikartik Khapar Rural Municipality were malnourished–a stark reminder of the urgent need for nutritional intervention. 

Broadening horizons and finding new opportunities

Although Niraj’s background is primarily in nutrition, he acknowledged that the SMNHS project broadened his expertise in maternal and neonatal health. He expressed his admiration for One Heart’s approach, noting, “The beauty of this project lies in its focus on both the software and hardware aspects of healthcare.”

Initially, Niraj had reservations about the feasibility of One Heart’s programs, given the limited staff and the challenge of covering every health facility while ensuring cost-sharing practices with local stakeholders for long-term sustainability. However, 

through continuous coordination with the local governments and working in tandem with their initiatives, they successfully created new opportunities for the program’s success. One such opportunity was to promote the culture of cost-sharing between local governments and development agencies. 

Tangible solutions

According to Niraj, this project’s focus on identifying problems and offering tangible solutions sets it apart. “After our intervention, the local government allocated funds for purchasing essential equipment and drugs for the birthing centers and conducting various trainings,” Niraj explained.

Thanks to his team at the Dalit Development Society and their persistent efforts, most Birthing Centers now have emergency drugs readily available. “After continuous follow-up with nursing staff, the Birthing Centers have ensured the availability of essential emergency drugs,” Niraj said.

Recognizing One Heart’s impact, he stated, “Even small interventions can create a significant impact when we effectively advocate for stakeholders’ involvement.” As a result of the project, not only has the local government provided essential equipment like Kangaroo Mother Care chairs and screens, but healthcare facilities have also undertaken minor renovations and organized maternal and neonatal health service flows.

Grateful for the collaborative efforts, Niraj expressed his appreciation, saying, “I am thankful for the continuous support from government health workers and the One Heart Worldwide team.”

Reflecting on his journey, Niraj remains committed to his mission and acknowledges the progress made. “I am continually working with full dedication; I am delighted to contribute to making every pregnancy safe,” he concluded, knowing that his efforts have significantly improved maternal and neonatal health in rural Nepal.

An inspiring journey of Nepal Advisory Board Member Mr. Achyut Luitel

By Naresh Newar

Mr. Achyut Luitel, a dedicated board member of One Heart Worldwide's Nepal Advisory Board, has a passion for improving lives that extends far beyond the boardroom. His journey began not in the world of healthcare but in the field of engineering. "I am trained as an engineer," Mr. Luitel shares, "but the health sector always fascinated me." This fascination, coupled with a deep-seated desire to contribute to social change, led him down a path that would eventually lead him to join One Heart Worldwide’s journey.

Starting as a government official, Mr. Luitel transitioned to the development sector, moving up quickly in various leadership positions in international non-government organizations since 1994. He was driven by a desire to make a meaningful difference in the lives of rural communities. His early work addressed the critical lack of potable water and sanitation facilities, recognizing their fundamental role in public health.  

A passion for community engagement

"The rural communities needed a lot of support," he recalls, highlighting the challenges faced by these underserved populations. His approach to community engagement was rooted in active listening and collaboration, ensuring that local voices were heard and their needs addressed. He worked alongside communities, understanding their unique challenges and aspirations and involving them in every step of the development process.

His passion for improving rural livelihoods then led him to infrastructural building, and he facilitated the construction of village roads and implemented livelihood programs. "We helped the government and local governments to make the village roads," he explains, emphasizing the importance of connectivity and economic opportunities for rural communities. Here, too, he prioritized community involvement, ensuring that projects were not only beneficial but also owned and sustained by the communities themselves.

Fostering teamwork and collaboration

Throughout his career, Mr. Luitel's leadership philosophy has centered on empowering individuals and fostering collaboration. "I really believe in people," he affirms, highlighting his commitment to building strong teams and creating supportive work environments. He emphasizes the importance of open communication, mutual respect, and recognizing individual strengths. "My door was always open for my colleagues," he shares, reflecting his approachable and inclusive leadership style. He believes in creating spaces where everyone feels comfortable sharing ideas, voicing concerns, and contributing their unique talents.

Engagement with One Heart Worldwide

Mr. Luitel's journey eventually led him to One Heart Worldwide, where he found our work aligned with his passion for improving health outcomes, particularly for mothers and newborns. Mr. Luitel shares how he deeply admires OHW’s work in Nepal, stating, "They are doing an amazing job...helping the government…establishing birthing centers, providing training and equipment." He believes our approach of strengthening existing healthcare systems and collaborating with local communities is key to creating sustainable and impactful change. This resonates with his own belief in the power of partnerships and community-driven development. 

Mr. Luitel is particularly inspired by the positive feedback from local communities and healthcare workers who have benefited from One Heart Worldwide's initiatives. "They are very happy with the way...One Heart Worldwide was working with them," he shares, emphasizing the organization's commitment to community engagement and collaboration. He believes that true progress can only be achieved when communities are actively involved in shaping their futures.

His dedication to One Heart Worldwide stems from a deep understanding of the challenges faced by mothers and newborns in Nepal and a belief that everyone deserves access to quality healthcare. He urges donors to recognize the importance of investing in maternal and neonatal health, particularly in Nepal, where the need is significant. 

"If you really want to help underprivileged people, then obviously more investments should be done in the health and education sector," he states. He highlights the alarming maternal and infant mortality rates in Nepal, emphasizing the urgent need for increased support. He believes that investing in organizations like One Heart Worldwide is crucial to addressing these challenges and creating lasting change.

Passion for innovation

Mr. Luitel's story is one of hard work, innovation, inspiring leadership, and a genuine desire to make a positive impact in his country. He is a strong advocate for innovation in development work, believing that it is essential for finding effective and sustainable solutions to complex challenges. "Innovation doesn't come easily," he acknowledges, "but you can really think about some new ideas when you brainstorm." He encourages drawing inspiration from local knowledge, collaborating with universities, and fostering a creative thinking culture. He shares his experience with Integrated Water Resource Management as an example of how innovative approaches can be successfully implemented and replicated to benefit communities.

Words of wisdom for young professionals

For young people aspiring to become development professionals, Mr. Luitel offers this advice: "You need to have passion," he emphasizes, highlighting the importance of dedication and a genuine desire to make a difference. He also encourages them to connect with communities, understand local contexts, and build trust. "You should speak their language, eat like them, sleep like them," he suggests, highlighting the importance of cultural sensitivity and empathy.

Karnali Province’s challenges for better healthcare, particularly maternal and neonatal, have intensified after the devastating earthquake on November 3, 2023. One Heart Worldwide’s team has been on the ground, taking every step necessary to re-establish quality services and ensure safe pregnancies and motherhood care. 

An Earthquake Strikes in Jajarkot 

I vividly recall the night of November 3, 2023, when the destructive earthquake struck Jajarkot and also caused a huge tremor in Rukum West, where I am stationed as the District Coordinator of One Heart Worldwide (OHW). At precisely 11.57 PM, my wife, our two-month-old son, and I were abruptly awakened by the massive tremor. Fearing for our safety as our house was not earthquake-resistant, we hurriedly gathered outside with the panicked crowd.

Amid the chaos, we sought quick information through the still-functioning internet and were confronted with news of numerous casualties, injuries, and widespread destruction. Being involved in maternal and neonatal health and as a new father myself, my foremost concern was for pregnant women, mothers, and infants.

Given the severe winter conditions in Rukum West and Jajarkot Districts, compounded by the earthquake striking at the onset of November, I worried about how women and babies were enduring the cold.

I immediately got a call from our Executive Director, Surya Bhatta, who shared concerns for my family's safety and provided information about the local situation, particularly the impact on health facilities. Taking immediate action, I communicated with my colleagues in Rukum, and they shared information about the destruction of two health facilities in the Ghetma and Chainabagar wards.

These wards, part of Sanibheri Rural Municipality in Rukum West, have been implementing OHW’s MNH program since 2022. While the Chainabagar Health Post faced complete destruction, the birthing center of Ghetma Health Post survived with minor damages, while the rest of the facility suffered severe damage.

Our team swiftly established medical tents in both wards, offering essential services like the Outpatient Department (OPD), antenatal care (ANC), and postnatal care (PNC). Despite improvements, the situation remains fragile. The Ghetma birthing center is in a semi-functional state. In Chainabagar, the Government created a make-shift birthing facility in a two-room house, kindly provided by a local family.

Essential medical equipment, including delivery beds, mattresses, carpets, birth preparedness sets, thermometers, tables, and chairs, has been supplied to medical tents and birthing centers. The dearth of quality birthing facilities was an existing concern even before the earthquake. 

For example, in Chainabagar, the Government's plan to construct a proper birthing center faced a hurdle due to the lack of government-owned land. OHW had expressed willingness to assist in building a birthing center on a cost-sharing basis, with plans underway to locate suitable land.

Our team on the ground is committed to providing extensive support. We are assisting government health service providers in securing a safe working space within the tents, where 25-30 pregnant women and mothers with newborns receive ANC and PNC services. Before OHW's intervention, the situation was dire, with all services confined to a single small room. The introduction of tents has significantly improved conditions, offering relief to both service providers and mothers in need.

Furthermore, Nurse Ganga BC, trained with OHW's support as a Skilled Birth Attendant (SBA), is actively involved in Chainabagar, contributing to birthing deliveries and PNC services.

Challenges ahead

Ensuring quality healthcare necessitates adequate space and effective management, both of which are currently lacking. The long-lasting impacts caused by this earthquake raise our concerns about the increasing trend of home births in the affected Districts. Families often express discomfort and a sense of insecurity in visiting the health facilities, which remain in a poor state. Additionally, the makeshift birthing facilities lack proper heating and hygiene conditions, posing risks to women's overall well-being. 

In Chainabagar, the only available space is two small rooms in a private household, and each room can barely accommodate a maternity bed. There is no additional space for 24-hour postnatal care. The rooms, situated in a cold rural municipality ward with a cement structure most suitable for summer weather, are challenging. Despite these constraints, four birth deliveries have been managed, with mothers and babies kept for a maximum of two hours before being sent home.

Accessing other health facilities from both municipalities poses challenges due to significant distances and difficult journeys. The nearest birthing center from Chainabagar is accessible by vehicle in at least 30 minutes. In contrast, Ghetma faces a more extensive journey of at least 2-3 hours, exacerbated by a lack of available vehicles and difficult off-road conditions.

Despite these obstacles, our team persists in reaching pregnant women in need. An eight-month-pregnant woman visiting our tent expressed optimism about positive changes resulting from our assistance. While signs of hope emerge among the local population, health workers, aware of ground realities and persistent challenges, remain cautiously optimistic, bearing the evident stress and burden.

One Heart Worldwide acknowledges a significant challenge: excelling in providing long-term solutions for maternal and neonatal health while recognizing the need to enhance immediate relief efforts during emergencies. Despite limited resources, our team diligently built medical tents - a crucial resource for government health service providers to have proper working spaces for delivering services to earthquake-affected mothers and the general population. 

There are still urgent needs, including emergency supplies like clothing, blankets, hygiene kits, and kitchen utensils for mothers. With the support of the German Embassy, we are prepared to deliver significant humanitarian aid, recognizing that the need for assistance among affected families remains critical more than 3 months post-earthquake.

The disaster in the region serves as a valuable learning experience. Given Karnali Province’s susceptibility to disasters like landslides, adequate preparedness is imperative. The earthquake has provided essential lessons, motivating One Heart Worldwide to intensify efforts to support mothers impacted by natural disasters.

To support One Heart Worldwide’s long-term earthquake relief efforts, click here.

As a field officer working in the remote Chharka Tangsong rural municipality of Dolpa district in Nepal, I often come across remarkable stories of resilience and transformation within communities that face significant challenges. One such inspiring individual is Paljum, and her story highlights the critical impact of the partnership between the Women Empowerment Centre (WEC) and One Heart Worldwide in implementing the Maternal and Neonatal Health (MNH) Program in Dolpa.

Paljum resides in Terang Ward 5, a high-altitude village situated 3,322.5 meters above sea level. While the landscape is breathtaking, life in Terang can be harsh for villagers with limited access to quality maternal healthcare. At 41 years old, Paljum has endured immense grief on her journey to motherhood. Her first child, born when she was 27, was stillborn. She lost her first baby as a stillborn, and another succumbed to malnutrition, while the third fell victim to pneumonia.

She was lucky that two of her children survived.

All of Paljum's babies were delivered at home without the help of a skilled health professional, a consequence of the absence of a birthing center in her village or nearby health facilities. The nearest one, Mukot Health Post, required pregnant women to undertake an entire day's journey, leading most in her community to opt for home deliveries.

During my visit to Terang village for a community perception program organized with the support of One Heart Worldwide, I had the privilege of meeting Paljum. Pregnant and uninformed about antenatal care checkups, she symbolized the lack of awareness prevalent in her community. Paljum's story touched my heart, prompting me to engage her in conversation to understand her experiences and challenges. 

Paljum's vulnerability and determination became evident during our conversation. A woman of few words, she represented the silent struggles mountain communities face due to a lack of information and knowledge. It was clear that her hardships extended beyond her pregnancy, as she managed household chores, tended to a herd of 100 goats, and cared for her family, including her elderly mother-in-law.

Our community perception program opened Paljum's eyes to safe motherhood practices, empowering her to prioritize her health and that of her unborn child. Despite the distance, she made the courageous decision to travel to the health facility for her first antenatal care checkup. The impact of this decision was particularly rewarding as a health professional, knowing that the counseling and information provided had made a tangible difference in Paljum's life.

Paljum's story is a testament to the transformative power of education, awareness, and community engagement. Her decision to give birth at the health post reflects the potential for informed choices even in challenging circumstances. This transformation is not just an individual victory but a collective achievement made possible through the maternal health program supported by One Heart Worldwide.

In Paljum's own words: "I would like to thank you for bringing this community perception program and raising awareness about the importance of ANC and PNC checkups and institutional delivery. Now, I will definitely go for my ANC checkup and choose institutional delivery. Thank you, OHW and WEC."

Paljum's story serves as a beacon of hope, showcasing the positive impact of clear communication, compassionate counseling, and community support. It is a reminder that, through collaborative efforts, we can make a significant difference in the lives of underserved communities, ensuring healthier futures for mothers and their children in remote areas like Terang village.

To donate to help educate more women like Paljum, click here.

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In the Sarlahi District of the Madhesh Province, one of Nepal’s seven provinces, One Heart Worldwide (OHW) initiated its maternal and neonatal health program (MNH) in 2021. Before we introduced our program, even though birthing centers were in existence, there was a severe shortage of skilled healthcare professionals.

OUR BEGINNINGS IN SARLAHI

Sarlahi is the first district in the Madhesh Province where OHW started its interventions to support local government efforts in strengthening the MNH system. The first step was to identify the gaps in service on the ground. Our assessment showed that there was low priority and poor understanding of the value of the minimum health standards (MSS) and implementing quality improvement processes. Many health facilities were in poor condition, most marked with a concerning ‘red label,’ indicating poor performance in service quality, maintenance, management, and care services.

Conducting needs assessments in rural municipality wards with high birth deliveries, OHW identified three critical areas that required attention. The first was renovations, followed by the capacity building of the health facility management team, improving clinical skills, and participation in Skilled Birth Attendant (SBA) training. Additionally, OHW identified equipment shortages and worked with the local governments for improvement in this area.

Access to healthcare providers was poor, with a marked lack of awareness among service recipients about how to access these providers. OHW mobilized the existing government infrastructure and networks to provide life-saving skills training to Female Community Health Volunteers (FCHVs) and other health professionals. This initiative raised awareness about the services these individuals offered as care providers.

Simultaneously, OHW undertook extensive renovation work and equipment provision to upgrade healthcare facilities. We also advocated for the recruitment of more service providers, particularly nurses, at local health facilities. These combined efforts considerably improved the quality of healthcare services, ensuring the smooth functioning of these facilities.

BOOSTING PARTNERSHIP LEADING TO EFFECTIVE GOVERNANCE 

The maternal and neonatal health (MNH) program in the municipalities of Sarlahi has significantly improved under OHW's guidance. Municipalities started offering free ambulance services, organizing free rural ultrasound services, providing free transport for antenatal care (ANC) check-ups, incentivizing institutional deliveries, and allocating budgets for facility upgrades. OHW played a vital role in creating awareness and instilling a sense of ownership among local governments, which led to these positive changes.

A NEW CULTURE OF INSTITUTIONAL CARE IN THE COMMUNITY

Community attitudes toward safe motherhood also saw a shift. The lack of awareness about government-provided services and allowances for institutional deliveries among communities was addressed by OHW. This resulted in an increase in ANC check-ups and a greater understanding of safe motherhood practices in local communities.

STRENGTHENING the HEALTH SYSTEM

System strengthening is another crucial aspect of OHW's program. This includes improvements in reporting mechanisms, budget allocation, and the overall management of rural health facilities. Management committees, consisting of ward chairs, community leaders, and health staff, became more involved in the planning and better management of health facilities. Budget planning and allocation improved, leading to effective utilization of resources, especially in the MNH sector. Reporting mechanisms and referral processes saw substantial enhancements, ensuring timely and efficient communication and improvements in the overall system.

Overall, the Birthing Centers are more systematic now. Before OHW intervention, Birthing Centers were poorly planned and managed. The improved system now helps nurses to do their jobs better and more efficiently. They have a better working space, files are in order, and medicines are properly stored. The service spaces in the birthing centers are more hygienic, and the equipment is better maintained and in place.

ENHANCED SKILLS AND KNOWLEDGE AMONG NURSES

The program also aimed to enhance the capacity of nurses through skill and knowledge assessments. Training for nurses was organized to fill the knowledge gaps utilizing OHW’s Simulation-Based Mentorship Program (SBMP), involving six monthly sessions simulating real-life scenarios. These efforts resulted in improved clinical work by the nurses, enhancing their performance in managing maternity and neonatal cases, IV usage, complication management, and the overall management of health facilities.

CHANGING BEHAVIORS THROUGH COMMUNITY WORKERS

OHW identified a lack of knowledge and awareness among mothers, pregnant women, and their caretakers about identifying danger signs during pregnancy. They initiated capacity-building workshops for Female Community Health Volunteers (FCHVs) and community health workers to educate them about life-saving skills and identifying potential risks during pregnancy. These efforts motivated FCHVs, empowering them to communicate effectively with mothers regarding government services, birth preparedness, antenatal care, and postnatal care.

The Birthing Preparedness Plan was introduced, which included providing Jiwan Suraksha cards containing essential information related to pregnancy, awareness around danger signs, and preventive measures to avoid pregnancy-related risks. Regular counseling by nurses trained through OHW support became a crucial component of the plan.

OHW provided ultrasound machines and training to nurses to enhance the government's free ultrasound services, facilitating free mobile camps in various municipality wards. This eliminated the need for pregnant women to travel long distances and spend money on ultrasound services.

FOSTERING GOVERNMENT INVESTMENT 

To foster greater accountability and involvement of local governments in MNH activities, OHW initiated cost-sharing partnerships. This new approach aimed to encourage local governments to invest in facility upgrades, nurse training, and health facility management. OHW engaged government stakeholders, shared budget and planning ideas, and actively promoted this partnership model. These collaborations enhanced the culture of cost-sharing at the institutional level and enabled local governments to allocate funds to health facilities and invest in human resources for MNH, such as nurses.

OHW's efforts extended to transforming the infrastructure and facilities at Birthing Centers, which previously faced numerous challenges. Many centers had poor building structures, unsanitary conditions, and insufficient life-saving equipment. Nurses had inadequate working and living spaces and often lacked proper fencing and privacy. OHW's program brought significant changes to these facilities.

EVIDENCES OF CHANGE: Before and after

A lot has changed since OHW arrived in Sarlahi. The before and after scenarios are evidence of that. The building structures were poor, the interiors were not clean, and hygiene conditions were subpar. There was a lack of skilled staff, and the surroundings were also not patient-friendly. The management was inefficient and disorganized, and there was a shortage of good life-saving equipment.

Many Birthing Centers were challenging to enter, causing discomfort for mothers and pregnant women seeking care. Nurses had insufficient space to work, and some Birthing Centers had flooded compounds or were overgrown with grass and marsh. They had no security, and cattle often grazed in the compounds. Some Birthing Centers were attached to other government offices, which led to a lack of privacy and safety concerns.

However, through the intervention of OHW, nurses now have safe working spaces, and Birthing Centers boast clean, hygienic, and spacious rooms that offer privacy. The centers have separate buildings dedicated exclusively to MNH care. This transformation motivates more women and their families to seek quality care and services. Additionally, better security measures and properly fenced areas ensure the safety and privacy of all involved.

We can see these improvements in various birthing centers: 

Chandranagar Health Facility:

At the Chandranagar Health Facility, vital equipment was previously stored away, largely underutilized, or left unused. The delivery room was inadequately prepared, lacking essential equipment for safe childbirth and antenatal care (ANC) checkups. There was no information on display. Typically, only a single staff nurse was present, and management was lacking. The medical cabinets were disorganized, life-saving medicines were not stored correctly, and the cold storage facilities were lacking. The maternity beds were in poor condition. Medicine was found in cartons and haphazardly placed outside like discarded items.

However, following extensive training and increased awareness efforts, the management of the health facility has been transformed. OHW's intervention prompted the municipality to acknowledge the poor conditions at the Chandranagar health facility, leading to a remarkable transformation. 

Sohadwa Birthing Center, Basbariya Municipality:

The health facility used a single room for multiple purposes, from ANC checkups to delivery and counseling. The infrastructure was lacking, and OHW's intervention resulted in dedicated spaces for ANC, PNC, and deliveries. The Birthing Center now offers an enhanced referral system and has even established an emergency unit, leading to a transformation that earned it recognition as a "zero home delivery ward" and model Birthing Center.

Laxmipur Birthing Center: 

The conditions were deplorable during our initial visit to the Laxmipur Birthing Center. The compound was frequently flooded, signifying a high level of negligence. The environment was unsuitable for pregnant women, new mothers, and babies, posing significant health risks.

The compound was occupied by cows, hens, roosters, and ducks, and visitors had to walk through water and mud to enter the health facility. Situated in a bustling marketplace, the toilet of the health facility was frequently used by the general public, leading to an unhygienic and unsanitary condition of the toilets. 

The ward office was attached to the health facility and attracted a constant crowd seeking general administrative services and documentation, further contributing to the chaotic environment. The presence of garbage was noticeable, and there was no secure gate to protect the Birthing Center. The nurses worked in a state of constant stress, feeling insecure, especially during night shifts. The facility was also visited by young men seeking internet access.

However, a transformative change occurred following the establishment of an agreement between OHW, the municipality, and Save the Children. OHW's intervention, combined with the municipality's commitment to a 50% cost-sharing partnership, resulted in the construction of a new Birthing Center. Save the Children provided additional support, including the construction of a boundary wall, an iron gate, and water management. This collaboration led to a clean and secure environment at the Birthing Center, instilling a sense of safety among mothers, pregnant women, and nurses.

Why Behavioral change is essential to improving safe motherhood practices

By Upendra Kumar Singh in Bara District

In the Madhesh Province, initiatives are taking place on the ground to help mothers from rural communities learn about safe motherhood practices with the help of the Maternal and Neonatal Health Program implemented by One Heart Worldwide (OHW) in partnership with the local government and NGOs.

Bara is one of our new districts where we started implementing our program in March 2023. We have been learning so much about the local contexts. Our biggest challenge has been changing social behaviors and attitudes, especially in underserved communities. 

I am sharing one such instance that is helpful context in understanding the social challenges we encounter in Bara District. In Thulo Lautan village of Karaiyamai rural municipality, we recently organized meetings for a health group for mothers using the self-applied tool for quality health (SATH). The SATH helps increase knowledge about safe motherhood practices by sharing information about available health facilities and educating them about accessing MNH services. 

We had invited pregnant women, lactating mothers, their mothers-in-law, and adolescent boys and girls, especially from the marginalized communities from the Dalit, Muslim, and other socially and economically disadvantaged groups. In addition, we also invited the local Mothers’ Group and its chair, locally elected representatives, and community leaders.

But to our dismay, we didn’t see any pregnant and lactating mothers because their mothers-in-law decided not to bring them to the Birthing Center since they had household chores and were too busy. Some said their daughters-in-law were new in the village and didn’t want to bring them out of the households.

As development practitioners, we have to make a stand and take action during these instances. We had to tread carefully and make a good case. So, we asked the local elected representatives and the Mothers’ Group to convince the mothers-in-law that this event would be meaningless without their ‘buharis (daughters-in-law).’

Even when it was getting late, we wanted to wait for the buharis. Finally, they agreed, and we were so happy to welcome them. We were so glad they participated because they helped us to understand the realities of the birth delivery system within their communities. 

During the event, we engaged the women in the ‘social mapping tool,’ which involves teamwork in creating their infographics using simple drawings of their households and other relevant information. These events also create a safe space for participants to trust each other, encouraging them to share their personal experiences. 

One of the lactating mothers shared her story about how her newborn was recently delivered at home and not in a health facility. We wanted to get more details that could help us understand why there are still such home birth delivery practices when trained nurses and health facilities are available. Unlike in the mountain and hill areas, the roads are much better, and transportation is not as difficult to find.

The mother shared that the key reason she delivered at home was that she could not get information from the nurse about the estimated date of delivery (EDD). In just 15 minutes of labor pain, she delivered her baby at home and didn’t have the time to visit the health facility. The Female Community Health Volunteer (FCHV) helped in the birth delivery, and it seemed that this was not the first time the FCHV aided in a home delivery.

We always cross-check the facts before coming to a conclusion about any case. The SATH is helpful for local communities to pinpoint what needs to change in their municipalities to make pregnancy safer. 

We spoke to a nurse who explained that mothers often don’t note the exact dates of their menstruation cycle and don’t come for regular antenatal care (ANC) visits once pregnant. This makes it difficult for the nurses to give the exact date of delivery in many cases. 

Another way to determine the EDD is through ultrasound and video X-ray, but the machines are often unavailable in local health facilities. To complete an ultrasound, women have to travel to the hospital in Kalaiya sub-metropolitan city, the main town center of Bara district. But for many reasons, most women cannot travel even when Kalaiya is close to their villages. Lack of timely ANC visits also means pregnant women are unable to create a birth preparedness plan with their health provider.

However, it is more than just a question of access to nurses or the health facility because the traditional cultural practices are still strong and contribute to many instances of home birth. The mothers-in-law explained that they had always delivered babies at home and questioned why their new buharis would make such a big deal of giving birth.

Based on our understanding and observation, we perceived that age-old birthing practices are still intact, and maternal health decisions are made not by the mothers but instead by their mothers-in-law. This is why development practitioners not only need to engage and educate expecting mothers but also their mothers-in-law, who are still the most influential decision-makers when it comes to women’s health in these communities. 

To prioritize behavioral change, development practitioners must earn the trust of the community to bring about social changes that will ultimately help promote safe pregnancy and motherhood. Behavioral change takes a lot of work and strategic planning. We must do more than parachute to some village, go with a video or poster, and complete a presentation. We need a holistic approach that makes sense. But to bring about change, we need information. We must communicate with the local people, get their perspectives, understand their contexts, and study the local cultural norms and practices. OHW and our partners are leading the way, using a comprehensive approach with tools like the SATH for positive behavioral change toward safe motherhood.

Upendra Kumar Singh is the District Coordinator of One Heart Worldwide in Bara

One Heart Worldwide (OHW) is a non-profit organization dedicated to reducing maternal and neonatal mortality rates in remote and underserved regions of Nepal. Founded in 2004, OHW employs a comprehensive “Network of Safety” model that includes training healthcare professionals and local stakeholders, providing essential medical supplies, upgrading health facilities, and raising awareness about maternal and newborn health. Through strategic partnerships and community engagement, OHW has reached a significant milestone of impacting 1 million mothers and newborns with improved access to maternal and newborn care in Nepal.

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Voices from the Field Series

By Kalsang N. Lama in Dolpa

Winter is a dangerous season, especially for pregnant women in the upper mountain villages like Saldang in Shey Phoksundo Rural Municipality of Dolpa district, which lies in Karnali Province, which is home to some of Nepal’s most remote and poorest villages. During the winter months, the health staff is unavailable, and the health facilities are not fully functional. Most of the local villagers also migrate, leaving the villages and heading south to warmer places for survival from the cold. In this context, there is a low flow of patients at the birthing centers, which is why these centers are frequently closed until the winter is over.

At the same time, this is a very risky situation for women, especially mothers and pregnant women, who remain in their villages and are unable to leave despite all the hardship.

Dawa is one such woman I recently met at her home during my visit to Saldang village of Shey Phoksundo Rural Municipality. I received information from community health workers about her pregnancy. She had not reached out to the health staff from the local health facility because she was too shy to share anything. That is the norm among many local women from her Gurung community who often hesitate to share about pregnancy, which they feel is a very private matter. This was why I wanted to visit her, as I have done with several other women like her.

Dawa is from Saldang village, nestled in the high Himalayan regions, adorned by the vast alpine meadow landscapes, and lies in Shey Phoksundo Rural Municipality, one of the many municipalities in which One Heart Worldwide (OHW) is implementing its Maternal and Neonatal Health (MNH) Program in partnership with Np WEC to save the lives of mothers and newborns.

She was happy to welcome me to her home, and we were able to forge a good bond. I soon won her trust and confidence, which helped me understand her maternal health history. She already has four children, all daughters, and her husband wanted a son. She told me that having a son was highly important in her community so that he would grow up to care for the parents.

Dawa didn’t want to get pregnant anymore, but she was unable to get counseling on birth control as the health facility was closed. Without her husband’s knowledge, she even took Depoprovera, which is a hormone used for contraception with an injection and whose effect lasts for three months. However, she was unaware of the need for regular intake as she was unable to reach the health workers and got pregnant even though she was trying hard to prevent it.

When I met her, she had anemia and low blood pressure, and I managed to get hold of a health worker at Saldang Health Post to give her an iron tablet and calcium capsule. I also educated Dawa about the importance of antenatal care visits, birth spacing, and effective family planning methods.

Today, she is more educated with our help. Even just a little bit of information can make such a difference in the lives of many women. There is a lot to think about regarding how we, as health service providers, can help rural communities, especially those living in such remote places as Saldang, where people have no access to maternal and neonatal health education or health workers. 

It is not just the winter season that causes difficulties but also a lack of clear communication when working with the women from local communities. Language is a big issue because health workers posted in government health posts are unable to understand and speak the local native languages. This is also why most women don’t want to visit the health facilities, as they are unable to speak Nepali fluently, which makes them unable to express and articulate their problems properly. This communication gap can deter the local community from understanding and practicing family planning.

The One Heart Worldwide team is also helping to identify the social and cultural norms and practices and other local contexts that are important parts of successful health intervention.

Kalsang N. Lama is the Field Officer of the Women Empowerment Centre (WEC), a partner organization of One Heart Worldwide in Upper Dolpa.

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By Naresh Newar

One Heart Worldwide brought together over 130 participants from across the world during the international webinar, ‘Maternal and Newborn Health in Nepal: Contributions from One Heart Worldwide,’ held on August 22, 2023. 

“We have a very special presentation about maternal and newborn health work that One Heart Worldwide is doing in Nepal,” said Mr. David Murphy, Board Member and Chief Executive Officer of One Heart Worldwide (OHW). He shared how the webinar had attracted a large number of people from around the world to this significant event.

“One of the important points we appreciate very much in Nepal is the support One Heart Worldwide has provided to the rural communities and families in Nepal. You have been able to reach people where the attention is needed the most,” said the Honorable Ambassador of Nepal to the USA, Mr. Sridhar Khatri.

Ambassador Khatri opened the webinar by highlighting and sharing critical issues related to the maternal and neonatal health (MNH) situation in Nepal and the progress that has been made. He also shared examples of initiatives and impacts made through One Heart Worldwide (OHW). 

Three prominent experts, Dr. Kirsten Meisinger, Dr. Swaraj Rajbhandari, and Mr. Surya Bhatta, were the key speakers presenting on the MNH issues considering the global, regional, and Nepal contexts and perspectives. 

Nepal in the global context

“In the United States and in Europe, maternal mortality is not decreasing. It's actually rising, and this has garnered a lot of information sharing from other parts of the world. I'm excited for us to be able to learn from our partners in Nepal to be able to reverse this trend in our own countries,” said Dr. Meisinger. 

Serving as the Board Chair of OHW, Dr. Meisinger is the Director of System Transformation and Leadership at Harvard Medical School Center for Primary Care. She is an international expert on Patient-Centered Medical Homes and healthcare system transformation. 

She explained how One Heart Worldwide's strategies have made a tremendous difference in a resource-poor environment.

“The simple fact remains that when your environment is resource-poor when your people are impoverished at a completely different level in Nepal than you are in the United States, you're still going to see the absolute numbers be dramatically different,” she added. 

She explained that action requires equitable access to health care and that working outside of the health care system is narrowly defined to address broader social well-being and development. 

“That framing is especially important for an organization like OHW, which has always operated from that principle of capitalizing on all of the strengths in society and going to the communities and transforming the entire Community to be able to improve the health of the family,” said Dr. Meisinger.

Beyond MNH: Humanitarian support by OHW

The webinar was moderated by OHW’s Board Member, Mr. Jagdish Upadhyay, who has over 40 years of experience in global health management. Among his prominent achievements include spearheading various new initiatives and global partnerships that successfully advanced UNFPA’s mandate to achieve universal access to sexual and reproductive health and rights. 

“When I visited the field and started looking at the facilities, I was told that most maternal death happens in facilities. So what One Heart Worldwide was doing was very important because they were equipping, training people, and providing support to health facilities,” said Mr. Upadhyay. He added how, in the municipalities where OHW implemented its MNH program in partnership with local governments, the Birthing Centers were functioning well despite the impact of the COVID-19 pandemic.

In this context of OHW’s support during the pandemic and disaster, Honorable Ambassador Khatri also shared that OHW has not only consistently supported Nepal in the health sector but also acted during times of difficulties in Nepal. 

“The contribution made by One Heart Worldwide in the post-earthquake 2015 and COVID-19 pandemic was very significant, and these are things that Nepali people will not forget for a long time because it is at these moments when friends act, and those memories become lasting for those beneficiaries who needed them so much,” he remarked.

Progress in Nepal, but disparities exist in the provinces

Dr. Swaraj Rajbhandari shared how Nepal has made remarkable in improving MNH and improving in reducing infant and under-five mortalities in comparison to countries in South Asia.

“This is due to various factors because of the policy strategy guidelines standards being in place, and the programs like the Safe Motherhood policy are also increasing in the number of skilled Healthcare Providers, having the free maternal Health Services, incentive schemes to improve the antenatal care, and the postpartum visits, birth preparedness package and also preparing for the complication management,” said Dr. Rajbhandari. 

Dr. Rajbhandari is a senior obstetrician/gynecologist with over 35 years of experience in clinical and technical leadership in maternal, neonatal, and reproductive, and has worked extensively in international public health in Asia, Africa, the Caribbean, and the Middle East. 

During her presentation, Dr. Rajbhandari shared that institutional birth delivery has really increased, and that is very good news for Nepal. But at the same time, she is very concerned about how disparity exists in various provinces. 

Inequality across all of the provinces is very high, and MNH is affected by various factors like social, economic, and geographic inequalities, among others. The MNH situation in Bagmati Province is much better compared to Lumbini, Karnali, and Sudurpaschim, where the maternal mortality ratio is high.

She shared that more than 50% of deaths occur among the 15 to 19 and 20 to 24 age groups. The legal age of marriage in Nepal is 18, but in many provinces and all over Nepal, child marriage and marriage before 15 is still very prevalent. 

“In the provinces Madhesh and the Far Western region, the girls are getting married before age 15, leading to early marriage, early childbirth, and the adolescent mortality is very high because they are not able to reach the health facility when needed. There is disparity among the ethnic groups like the Madheshi Muslims because they also get married at a very low younger age group, and the mortality again is very high,” said Dr. Rajbhandari.

OHW’s close partnership with the Government

Mr. Surya Bhatta explained how OHW has always worked closely with the government to strengthen the already existing system and health infrastructure. OHW’s approach has fostered a spirit of partnership and hope for change, especially among rural municipalities, which have started to invest on a cost-sharing basis for rural facility upgrades and have expanded its MNH program across Nepal.

“We started our program from eastern Nepal and moved up to the middle hills, and now we are strategically moving into the Karnali and Madhesh provinces where most of the health outcomes are comparatively poorer than the national average,” said Mr. Bhatta, who is the Executive Director of OHW, a graduate from Dartmouth College with an MS in Healthcare Delivery Science with extensive experience in serving public health in Nepal.

He shared OHW’s Network of Safety model, which focuses on actively engaging key government and community actors to contribute to strengthening rural MNH care.

OHW has helped to train about 21,000 Female Community Health Volunteers, renovated or constructed 160 birthing centers, equipped around 500 birthing centers, and trained around 700 Skilled Birth Attendants. OHW has also trained around 171 SBAs on ultrasound training and rural ultrasound training. In addition, over 18,000 stakeholders have been trained to improve health facility management and local health governance. OHW helped in quality intervention for around 500 health facilities to improve the service readiness and service quality of Health Facilities. 

“We will be reaching 165,000 annual pregnancies per year in 21 districts covering the 6.6 million population. We have already reached 1 million lives, pregnant women and newborns,” said Mr. Bhatta. 

You can watch the full webinar by clicking here, or you can click on the video below.

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Myagdi District in Gandaki Province is a breathtaking destination adorned with beautiful mountains and hills, attracting nature tourists, especially mountain climbers and trekkers. After a three-hour drive from the renowned city of Pokhara, one arrives at the district's well-developed business hub, Beni Bazar. The town offers a splendid view of the Dhaulagiri mountain range, home to revered peaks like Annapurna, Nilgiri, Churain, Manapathi, and Gurja.

Myagdi is also known for being home to many foreign migrant workers who contribute to the local economy through remittances. There is a strong sense of community, and the district boasts the highest GDP per capita in Gandaki Province.

Challenges in Maternal and Neonatal Health (MNH)

Despite economic progress fueled by remittances and tourism, Myagdi faces challenges establishing a quality MNH system, particularly in remote areas. In 2021, One Heart Worldwide (OHW) partnered with the local government to launch an MNH program, prioritizing underserved communities who live far from adequate health facilities. These communities were identified through baseline studies while also considering geographical factors, socio-economic contexts, and MNH indicators in the district.

The initial phase of our work coincided with the COVID-19 pandemic, which had a significant impact on Myagdi. The district experienced lockdowns, followed by local, provincial, and federal elections, while also dealing with heavy monsoon rainfall. Despite these challenges, our dedicated team persevered, implementing our program initiatives.

Our focus centered on pregnant women and mothers. Baseline reports revealed a high number of home births due to local cultural practices, social norms, and a lack of awareness surrounding MNH care. Many pregnant women were unfamiliar with how to prepare for their delivery, and the absence of well-equipped birthing centers and trained nurses limited their options.

For OHW, encountering cultural and social norms in underserved communities is not uncommon. However, we saw this as an opportunity to transform the community's perception and build trust in institutional birthing care. The key was to demonstrate the impact of our work.

Soneeya, a recent new mother, shares her experience: "We never had such a health education program in our village. Today, we know the importance of providing good care during pregnancy and after birth delivery." Soneeya participated in OHW's community interaction program held in Raghuganga Rural Municipality. These activities provided a platform for knowledge sharing and facilitated conversations on birth preparedness and antenatal and postnatal care involving pregnant women, recently delivered women, family members, and caretakers.

Collaboration with the Local Government

Since One Heart started working in Myagdi, we have fostered a collaborative partnership approach, engaging in cost-sharing arrangements with the local government. This collaboration involved organizing capacity-building training sessions such as health planning and budgeting workshops and conducting review meetings and dialogues with Palikas (local governing bodies). These efforts resulted in effective resource allocation and budget management.

“Before receiving this training, we had limited understanding of the functions, fundamental roles, and responsibilities of HFOMC members, as well as how we could contribute to the health facility to ensure the delivery of excellent services,” says Path Bahadur Roka, Chair of HFOMC from Darbang Primary Health Care Center (PHCC) of Malika rural municipality.

He shares how, over the course of the two-day training, the members gained valuable insights into the essential aspects of managing a health facility effectively. Equipped with this newfound knowledge, they feel determined to apply our learnings and experiences to enhance the overall healthcare system of their PHCC).

“We extend our heartfelt gratitude to One Heart Worldwide and the health section for organizing such a fruitful training session for us. This opportunity has been invaluable in equipping us with the necessary tools and understanding to make a positive impact within our health facility,” says Roka.

After nearly three years in Myagdi, OHW is entering the final year of the project's active implementation phase. To ensure a continued impact on MNH care in Myagdi, we are transitioning all responsibility for ongoing activities, proper management, and resource utilization to the local government. By leaving behind structural and non-structural resources, the local community can take ownership of improved MNH outcomes that we believe will be sustained for many years to come.

Recently I had the opportunity to speak with Dr. Meisinger, learned about her profession as a family medicine physician, her experience working with healthcare transformation both in the United States and internationally, and heard about the time she spent in Nepal with OneHeart.

Dr. Meisinger says that she decided to attend medical school because she “didn’t have a better idea” of what to do with her science degree from Brown University. Once in medical school though, Dr. Meisinger found that she “really loved every specialty”, and wanted to find a way to do it all in her career. 

She found that she was able to do so in the field of Family Medicine, a specialty that is based in the “philosophy of person, family, and community”. Because of how comprehensive the field is, Family Medicine is very complex and can present challenging cases, and each patient presents with their own unique story that a family physician uncovers over time.

Dr. Meisinger values seeing her patients as people, and deeply cares about the stories that her patients bring with them from outside of the office. It’s clear that this is the case from the extra time Meisinger puts in outside of the office to not only understand medicine, but understand lifestyles, customs, and cultural heritage that shapes the lives of her patients.

The other key component to Mesinger’s philosophy as a physician comes from the teams-based system of care she has worked to implement on an international scale. “People describe the patient-doctor relationship as a sacred space, and we want to build confidence and trust of the patient in the clinical environment as well”. In a setting where the doctor is the sole provider and holds all responsibility for the care of the patient, not only does this decrease the efficiency of care, but it can also lead to burnout of physicians. Making primary care a shared responsibility among multiple people helps to improve healthcare in both quality of care and quantity of patients seen. 

Implementing this shift in the structure of care in primary clinical settings is referred to as primary care systems transformation. In 2008, the primary care clinic Dr. Meisinger worked at started this shift towards team-based care, and since then, Meisinger has worked on systems transformation for Family Medicine on an international scale. She is the current Director for System Transformation and Leadership at the Harvard Medical School Center for Primary Care.

“The process of transformation is to take something and make a fundamental change to it. There is a wholesale change to something from what you started with.” Meisinger says. Early in her career as a Family Physician, a doctor was expected to identify and explain a problem, along with screening them for preventative factors, all within one 15-minute appointment. As it stood, being a primary care doctor was a job that “nobody could do for long without exhausting themselves.” It was a field that needed some type of fundamental change to its organizational structure, or a transformation. The transformation of this primary care system comes from including other medical staff members in the office in the chain of care. Now, the job a doctor was expected to do approximately 30 years ago is split among 7 people, says Meisinger. Receptionists, nurses, and doctors work together, both in-office and online through patient portals, to improve patient care. Community Health workers connect people who need care to the health center.

When she started practice, Dr. Meisinger cared for approximately 700 patients; now, with team-based care, her panel is around 2,000 people. 

Dr. Meisinger grew up in Washington Heights, NYC, where “everybody is from somewhere else,” as her own father, who emigrated from Europe during WW2. She finds herself most comfortable as a “citizen of the world” as someone who is fluent in Spanish, Portuguese, and French. This international draw and language proficiency has led her to work internationally on systems transformation in Australia and in Brazil.

In 2018, Dr. Meisinger received her master’s degree in Health Care Delivery Science from Dartmouth, where she met Surya, the current executive director of the Kathmandu team of One Heart. As a doctor who was seeing an influx of Nepali patients coming from Kathmandu but was relatively unfamiliar with Nepali culture, Dr. Meisinger sought out knowledge from Surya to help her understand some of the complexities of the culture so that she could better understand and better treat her patients. The two became friends during the course of their master’s program.

Surya introduced Dr. Meisinger to One Heart during her time at Dartmouth. The two of them got a team together to do an Action Learning Project, which is a project designed to apply theories they were learning about in their program to a real-world situation. The project focused on improving the medicine distribution system in Nepal, and was so inspired by the work of One Heart, she remained connected to One Heart after her work in her master’s program was done.

Dr. Meisinger stepped into her position as board chair in June 2023. She wants to ensure that One Heart continues promoting high-quality care and maintains its status as the “well-regarded organization it has been up to now.” 

When I asked Dr. Meisinger about what in particular she liked about the organization and strategies One Heart uses to provide care, she noted, “two pieces of the work at One Heart that are done exceptionally well.” One is the government extender program, which allows One Heart to work directly with the government of Nepal to ensure that the work done by the organization will benefit areas in need. This also allows One Heart to eventually exit the area and turn care over to the government, which will be responsible for the less costly but incredibly important maintenance of the health centers.

The second piece comes from quality improvement. This is “using quality techniques to implement transformation successfully,” which One Heart does use run charts to ensure that they are following protocols and keeping up with high-quality standards. Dr. Meisinger saw this commitment to quality improvement firsthand during her visit to Nepal, where she noticed the nurses and skilled birth attendants constantly referring to their run charts to check that their actions matched the protocols. “You can’t get many US hospitals to do this type of thing, but in this birthing center on the side of a mountain in rural Nepal, they are committed.”

I wanted to know if there were any other memorable aspects of her trip to Nepal, and Dr. Meisinger told me that she will always remember the placenta pit. Dr. Meisinger was unfamiliar with this concept before her visit, but a skilled birthing attendant working at the center kindly showed her one, which was a hole covered with a metal grate. “I learned that they discard the placenta there. It’s to keep the wild animals from coming into the birthing center. What type of wild animals? I asked. And the attendant said, ‘Oh, just the tigers mostly.’ And I learned something new that day. We don’t really deal with tigers in Boston'!” 

Dr. Meisinger is both excited and committed to her new position as board chair of One Heart. Not only does Dr. Meisinger bring plenty of prior experience and expertise to her new position at One Heart, but her dedication to making lives better and her compassion will make her an asset to the team. One Heart is excited to continue its mission to save lives and promote well-being in Nepal with Dr. Meisinger at the helm of the Board.

Dr. Meisinger will be a speaker for a webinar hosted by OHW titled “Maternal & Newborn Health in Nepal: Contributions from One Heart Worldwide.”

Join us on Tuesday, August 22, at 7 am Pacific / 10 am Eastern / 7:45 pm Nepal to meet our new Board Chair and learn more about the status of maternal health in Nepal right now! 

The treacherous, winding roads of Baglung are not for the faint of heart. Often unpaved, nestled along the side of a cliff, the road to get to the village of Narayansthan is often prone to falling rocks and opens to one of the deepest gorges in Nepal, making the journey a very dangerous one. 

Arlene Samen, the founder of One Heart Worldwide, traveled these roads to get to Narayansthan, where she and other team members spent the night at a female community health worker’s house. They were accompanied by The Social Welfare Association of Nepal (SWAN), another nonprofit working for the betterment of women and children in Nepal.

Around 9 pm that night, there was a knock at the door. A woman was in labor, and she needed help. Immediately, a midwife from the team went to go visit the young woman, but by the next morning, the woman still had not given birth. Arlene, a trained nurse practitioner, went to provide aid. “She was completely worn out, and the baby wasn’t coming down,” Arlene remembers. She decided that this birth had complications that required access to a hospital - and fast.

The roads leading to the hospital in Baglung were anything but fast and would require the team to go all the way around the cliff in order to get her there. Worried that they didn’t have enough time, the team decided there had to be another way. With no access to an ambulance service, the next best method of transportation was to use the stretchers One Heart had recently given to the community. Those helping the expectant mother put her on a stretcher, and instead of losing time by going around the cliff, men in the village carried her over a large bridge where “they traversed down the cliff and then back up it, barefoot,” in order to get to the hospital.

When the team finally reached the hospital, the young mother was able to successfully give birth, saving the lives of both the mother and the child. Luckily this story ended in success, but Arlene recognized that she wanted to do more than assist with one birth in the village, “I just remember at that time thinking, what if we hadn't been there. I just kept thinking that she wouldn't have made it.” After seeing how difficult it was to gain access to high-grade medical care, Arlene and the One Heart team decided that this area of Baglung District would be the perfect location to construct the first One Heart Birthing Center in Nepal. 

Since the construction of the first birthing center, One Heart Worldwide has grown to be an internationally recognized NGO that works directly with the Government of Nepal to provide high-quality medical care to mothers and their children. One Heart employs its Network of Safety model to set up and implement the program, and then transition the responsibility of care to local medical providers and skilled birth attendants.

“Understanding the cultural and spiritual practices in each of the communities, and focusing on the family first” were some of the most important aspects to Arlene in the design and implementation of the Network of Safety strategy in order to ensure the work done by One Heart aligned with the community values and ideals. Another key aspect is flexibility. “The foundation should be understanding what the people need, and us designing our interventions around that”, Arlene believes. “This is how you leave a footprint”. 

Now, in July 2023, One Heart has reached one million mothers and newborns in birthing centers that have either been constructed or upgraded in 32 districts of Nepal. The Hatiya Birthing Center, constructed near Narayansthan, has reached over 1,500 births since One Heart’s work began in Baglung District in 2011. 

When we asked Arlene about what it means to her now that One Heart has facilitated the impact on one million mothers and newborns in Nepal, she remarked, “It means to me that we still have a lot of work to do. Every mother should have the same access to care.” Nepal has 77 districts, and by the end of 2024 One Heart will have impacted 36 of them. Arlene hopes to eventually cover all of Nepal with the Network of Safety model, with continued partnership with the Government of Nepal. 

In addition to the Network of Safety, Arlene says that “staying focused on our mission”, and “collaborating” with other team members, organizations, and the people that One Heart helps are instilled in the center of the work One Heart does. 

If you would like to learn more about Arlene and her story with One Heart, please join us on Wednesday, July 12th @ 6 pm Pacific / 9 pm Eastern to celebrate Arlene’s 70th birthday and our 1 million milestone! Click here to RSVP for the event.

In the heart of Dolpa, a remote district in Nepal, lies the Liku Health Post, a lifeline for the local community. This health facility has faced numerous challenges over the years, but thanks to the support of WEC (Women Empowerment Center), changes are taking place to improve services for mothers and newborns, bringing hope to the local communities.

WEC is an NGO local to Dolpa and one of One Heart Worldwide's partner organizations.

Led by the Ward Chairperson of the Palika, Mr. Lalit Parsad Giri, along with the active participation of the HFOMC (Health Facility Operation and Management Committee) members, and service providers, the community launched an initiative to provide much-needed equipment to the Liku Health Post in Tripurasundari Municipality. OHW & WEC were the sole funders of a significant contribution of NPR 152,030.20 (USD 1158.86) made to ensure the availability of essential resources.

During our initial visit to Liku Health Post, it became apparent that they needed more equipment with better organization. The health staff was unaware of the required amount of equipment in each set, posing a risk to the lives of mothers and newborns, especially in emergencies. However, the Health Post has progressed since then, with major equipment sets now complete. The HFOMC members, who were previously unaware of the unit cost received by the health facility, have now gained knowledge about it and understand how to allocate the financial resources received effectively.

Critical problems we are addressing

In the past, women in this area of Nepal have faced significant difficulties during childbirth due to a lack of early detection for complicated pregnancies. However, thanks to OHW/WEC's support and the training provided to Dharmadevi B., a Senior Auxiliary Nurse Midwife (Sr.A.N.M.) at Liku Health Post, the available resources, including the RUSG (Real-Time Ultrasonography) machine, are now being utilized to their fullest potential. Early diagnosis of complicated pregnancies has become possible, leading to the prevention of maternal and neonatal complications. 

Lalit Parsad Giri, the Ward Chairperson, played a crucial role in facilitating the program and expressed his deep appreciation for OHW/WEC's contribution, acknowledging that it would motivate the staff and enhance the quality of services provided by Liku Health Post.

"Thank you, OHW/WEC, for your support to this health facility; I believe this will help improve the health of mothers and children of our village. I assure you that we will properly use this equipment," said Chairperson Giri.

The event, held on 17 February 2023, witnessed the active participation of various stakeholders, including the Ward Chairperson, HFOMC members, nursing staff, health facility staff, and the SMNHS (Safe Motherhood and Newborn Health Support) project advisor from Dolpa. Although the Municipality Chairperson, Mr. Jana Chandra Rokaya, and the Municipality Nursing Focal Person, Mrs. Sangita Budha, were unable to attend, they assured their participation in the upcoming BC (Birthing Center) equipment support program in Pahada Health Post, scheduled for the following day.

The event aimed to provide essential equipment to the birthing center, thereby improving the quality of services offered by Liku Health Post and enhancing maternal and neonatal health outcomes in the region. It was also an opportunity to raise awareness among the local community about the availability of high-quality equipment at the birthing center and to make the HFOMC accountable for the sustainable and proper utilization of these resources.

Capacity building: A key factor for bringing change

HFOMC members received orientation on the proper management of resources, unit cost analysis, and maternal incentives, all aimed at improving the quality of health services at Liku Health Post. Recognizing the high institutional delivery rates in the municipality and a remarkable increase in institutional deliveries, with only one reported home delivery in the past three fiscal years, OHW/WEC identified it for renovation support. An OHW engineer visited the Health Post in April 2023 to assess the requirements for the renovation.

The RUSG training provided to Senior ANM Dharmadevi Bohora has not only enabled her to identify and prevent high-risk pregnancies in remote villages but has also led to the provision of regular services to pregnant women through RUSG mobile camps, combined with ANC/PNC (Antenatal Care/Postnatal Care) services, throughout Tripurasundari Municipality. 

She expressed her gratitude to OHW/WEC for the equipment support stating, "Visiting this health facility recently, I am impressed with the working modality of OHW/WEC. I am now more confident and motivated to provide quality delivery services, as we lacked complete sets before."

Health workers, HFOMC members, and local stakeholders attended the equipment support event. The local community and health staff praised OHW/WEC's contribution and expressed gratitude for the support, believing it would significantly improve the quality of services.

Creating Hope for Change

Despite the challenging context and harsh geography, the Liku Health Post has consistently delivered commendable health services. The enthusiastic and motivated health staff, supported by an engaged management team, has achieved impressive targets, as evidenced by the HMIS (Health Management Information System) data. OHW/WEC's integrated monitoring has facilitated the self-identification of issues and needs within the health facility, further reinforcing the delivery of quality services.

With active and consistent efforts of OHW/WEC's community-level activities, mothers' knowledge about safe motherhood is steadily improving. The birthing center at Liku Health Post has maintained a streak of zero home deliveries over the last three fiscal years, a remarkable achievement given the challenges faced in the ultra-rural Dolpa District. The support provided by OHW/WEC will contribute to reinforcing and sustaining these efforts and achievements, ensuring better maternal and neonatal health outcomes for the local community for many years to come.

Reena Khulal, Dolpa District Coordinator, One Heart Worldwide

Sudeep Dhungel, Field Officer, Women Empowerment Center

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In the Haripur municipality of Sarlahi District, there was remarkable success at the local Primary Health Center (PHC). Nurse Shrijana U. played a significant role in saving the life of Laxmi B., a 20-year-old first-time pregnant mother, using the MNH Helpline supported by One Heart Worldwide.

The story starts on July 17, 2022, when Laxmi arrives at the Haripur PHC around 4 pm. Despite her condition, she had walked for 15 minutes, enduring physical discomfort to seek medical assistance. Laxmi presented with alarming symptoms: a severe headache, blurred vision, vomiting, dizziness, and epigastric pain. Recognizing the urgency, Nurse Shrijana promptly assessed Laxmi's vital signs, noting potential danger signs for both the mother and the baby.

Using the MNH helpline at a critical time

Laxmi had arrived at the right time - the PHC had recently conducted a monthly session on Pre-Eclampsia and Eclampsia as part of the Skilled Birth Attendant Mentoring Program (SBMP). During this session, Nurse Shrijana and her colleagues gained knowledge and skills in managing such cases. The information from the SBMP session allowed them to identify Laxmi's condition as severe pre-eclampsia, a potentially life-threatening complication.

"Previously, we were so confused about diagnosing Pre-Eclampsia and Eclampsia, but the monthly SBMP by our mentor, Anju Thakur, helped us learn so much," said Shrijana.

In a crucial decision-making moment, Nurse Shrijana and her team at Haripur PHC turned to the MNH Helpline for expert guidance. Dr. Gautam Jha, MDGP, a highly experienced doctor at the Provincial Hospital in Malangwa, promptly answered their call. Nurse Shrijana described the situation, and after a brief discussion, Dr. Jha recommended administering 10 mg of Nifedipine orally and the loading dose of Magnesium Sulphate. He also advised transferring Laxmi to the Provincial Hospital in Janakpur due to the unavailability of NICU services at the local hospital.

With newfound confidence from the SBMP and the guidance received from Dr. Jha through the MNH helpline, Nurse Shrijana, and her team swiftly took action. They educated Laxmi and her visitor about the situation, the necessary procedures, and the importance of referral. The team made all the necessary arrangements, including organizing finances and ensuring blood donor availability. Aware that severe pre-eclampsia requires delivery within 24 hours, they called an ambulance from Laxmipur Kodraha Health Post to transfer Laxmi to the Provincial Hospital in Janakpur.

A perfect example of team spirit

While waiting for the ambulance's arrival, the nursing staff mobilized their efforts to manage Laxmi's condition. One nurse prepared the loading dose of Magnesium Sulphate. Others focused on catheterization, opening an IV line, and providing counseling to Laxmi's family. During this time, they received another call from Dr. Chandan Raj Sharma, who further guided them on managing the case. Meanwhile, Dr. Gautam Jha maintained contact, providing valuable follow-up support.

Upon reassessment, Laxmi's blood pressure remained at 160/100 mmHg in both arms, prompting the nursing staff to forego a second dose of Nifedipine. Ensuring meticulous documentation, they recorded the vital signs, medications administered, and the timing of the loading dose in Laxmi's ANC card and OPD card since no referral slip was available. They also verified the normality of Laxmi's blood clotting factors based on her previous lab results, avoiding the need for a bedside clotting test.

When the ambulance arrived, the nursing staff took Laxmi's vital signs and fetal heartbeat one last time before her transfer. With a blood pressure reading of 160/100 mmHg, a pulse rate of 82 beats per minute, a respiration rate of 18 breaths per minute, a temperature of 97.4°F, and oxygen saturation at 94%, they determined she was stable for the journey. They also assessed the toxicity of Magnesium Sulphate, finding no signs of adverse effects.

At 5:30 pm, Laxmi Blon traveled to the Provincial Hospital in Janakpur, accompanied by Nurse Shrijana's well wishes and continuous communication with Ms. Pushpa Jha, the in-charge of the Maternity Ward at the hospital. The journey lasted three and a half hours, and upon arrival, Laxmi received immediate attention from the medical staff.

A mother's gratitude towards the empowered nurses

The long night passed, and at 6 am on July 18, 2022, Laxmi delivered a healthy, 2750-gram (6 lb.) baby girl through a cesarean section. Throughout her delivery, Laxmi remained on a maintenance dose of Magnesium Sulphate, as recommended by Dr. Gautam Jha. Both mother and baby were stable, and their condition steadily improved over the following days.

Reflecting on this extraordinary success, Nurse Shrijana expressed her delight and gratitude for the opportunity to promptly manage and refer the case.

"I was so grateful that I could learn so much from the SMBP program and the MNH Helpline. Only having academic knowledge isn't enough, but we need constant, expert guidance and advice," said Shrijana.

She added how the MNH Helpline significantly boosted her confidence, proving that knowledge alone is insufficient—expert guidance and advice can make all the difference.

Laxmi expressed her heartfelt appreciation for the kind and helpful nursing staff at Haripur PHC, who provided medical care, ensured her emotional support, and facilitated communication with her husband overseas.

In the end, Laxmi and her baby girl overcame severe pre-eclampsia, all due to the combined efforts of Nurse Shrijana and her dedicated team at Haripur PHC. Their commitment, skill, and valuable support from the SBMP and MNH Helpline saved a life and gave hope to the family.

This success story is a testament to the transformative power of knowledge and compassionate care in the face of adversity.

"I am so satisfied with the support from the nurses for saving us. I was afraid about my condition and my baby. Since my husband is working abroad, I am all alone here. They did everything for me, from arranging an ambulance to taking care of me and saving both of our lives," said Laxmi.

NOTE: None of the images represent a real person but are used only to illustrate the story with the use of Generative Artificial Intelligence art tools

To learn more about One Heart Worldwide’s impact and what we are doing to improve maternal and neonatal health outcomes in Nepal, click here to learn more.

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