Evaluating Maternal and Child Health in Post-Earthquake Nepal
The 7.8-magnitude earthquake that struck Nepal in April 2015, and its 7.3-magnitude aftershock, killed nearly 9,000 people, and the overall damage throughout the country was estimated to total $10 billion, about half of the small Himalayan country’s gross domestic product. Nepal Public Health Foundation (NPHF), founded in 2010, became a leader in the recovery effort, working to rebuild the country’s health and public health system and improve over the pre-earthquake status quo, says MPH student Victoria Pae.
Now, Pae, in a practicum supported by the Santander University Scholars Program, is quantitatively and qualitatively evaluating the foundation’s progress in maternal and child health.
“By the time I leave, the foundation will have a better understanding of the different barriers to maternal and child health interventions, what has worked and what hasn’t worked, areas for improvement, strengths and limitations to programs, and what to seek to improve on next,” Pae says.
That understanding has taken on even greater importance following Nepal’s 2017 elections, with the new government centralizing the country’s health and public health systems, moving these responsibilities from the districts to the federal government. “Now, many of NPHF’s efforts are to not only improve maternal child and health outcomes, personal hygiene, nutrition, and non-communicable diseases in Nepal,” Pae says, “but also to ensure that the government has the resources and education to take on the responsibilities of these district offices.”
Working with NPHF during this transition is an invaluable experience, Pae says, allowing her to learn about the country’s wider political system and how it plays out in public health. “There’s this constant question of whether the government will be engaged once this handoff occurs,” she says. “So far, it seems very positive, but depending on how the health system will look—which is currently being discussed at the national level—it may change how projects and studies are designed, who the stakeholders are, and the funding of projects. Discussing these topics have made me very aware of different stakeholders and how important it is to continuously engage them in public health work.”
She also has the opportunity to work with these stakeholders firsthand. “Stakeholder engagement and motivation has been such a huge part of the work we do at NPHF,” Pae says. “Learning to communicate with different bodies has been an extremely valuable experience.”
So far this summer, Pae has worked on evaluations for NPHF two projects: Strengthening and Activating District Health Systems (SAHaS), and a district investment case project. The SAHaS project works with 72 village development committees in nine of the districts that had been most devastated by the earthquake. Pae is assessing one part of the project, to improve the functioning and effectiveness of mothers’ groups, which hold local community meetings led by a female community health volunteer to raise awareness and conduct trainings on different health issues and local governance.
The other project, which began in 2012 and ended in 2017, is a strategic, evidence-based, problem-solving approach to support better maternal, neonatal, and child healthcare planning and budgeting in five districts. For her analysis, Pae is comparing maternal, newborn, and child health indicators from 2012 and 2017 to provide a clearer picture of the maternal and child health problems revealed by the project, and to identify barriers to better coverage and performance.
Pae is one of four SPH students working with NPHF this summer. She says the connection between the school and the foundation is thanks in large part to the relationship between Lois McCloskey, an associate professor of community health sciences whose public health career began in Nepal, and NPHF’s founder and executive chair, alumnus Mahesh Maskey (SPH’01), as well as Raj Subedi, NPHF’s monitoring and evaluation manager.
This is Pae’s first time abroad, and she says this summer is vital to prepare her for a career in global maternal and child health. From talking to village female community health volunteers and government officials alike, to the cultural immersion of weekend trips around the country and cheering on England in the World Cup over dinner with her host family, Pae says, “this practicum has been such a rewarding experience.”