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Transforming Health in Yamphudin

The Himalayan Trust UK health team first visited Yamphudin in 2015. The very poor, remote mountain villagers there were desperate for our help. They enthusiastically partnered with us for five years, and together we transformed their health knowledge, behaviours, services and outcomes.

Delivery room before and after


Yamphudin Ward lies in Sirijangha Rural Municipality, within Taplejung Province in the far north-east of Nepal. In general, the community is agricultural, multi-ethnic, and practices Buddhism and Shamanism.

When we started our programme in 2016, over 70 percent of villagers initially sought health care from the faith healer, with less than a quarter attending the health post first. Husbands and mothers-in-law usually made the decisions on pregnancy and family health. Women told us they were frightened to get pregnant. In their last pregnancies, almost all had delivered at home, with help from relatives or friends – and a few alone in the fields. It was traditional to keep newborn babies in smoky rooms.

Umesh Rathor, then the health worker running the Yamphudin Health Post, made the shocking statement that ‘In the last 10 years, at least 10 women have died in the village due to complications of pregnancy and delivery.’ Community leaders said the same, including the previous Ward Chair, whose wife had died in childbirth.

The health post was earthquake damaged, threatened by a river and had very few facilities. Neither of the two male health workers had midwifery training. There was no delivery service, so Umesh used the delivery room as his bedroom. On the limited occasions when women attended for antenatal care, he examined them on his bed, as nothing else was available.

Between 2017 to 2018, we built a new fully-equipped health post and birthing centre. The management team was trained and supported. Among other successes, it negotiated for an allocation of six staff paid for by the government, including two midwives. With scholarships, we provided higher training for one of the midwives and basic professional training for another staff member. All posts were filled. We provided drugs and supplies until local procurement was sorted. The facility was readily government certified and we handed it over to the community in 2019. We continued to train on data, governance, and standard procedures for infection control and hygiene.

In the community, we set up an innovative Community Fund for Medical Emergencies, based on a local financial cooperative and chaired by a Female Community Health Volunteer. This provided a safety net for the most disadvantaged families. Also, we ran a comprehensive Community Health Awareness Programme in the Women’s Groups at grassroots level throughout the Ward. This aimed to increase health knowledge and appropriate use of the improved health services. Men and older women also attended and a wide range of topics were covered, including postnatal care and nutrition. Alongside those meetings, the health post workers supervised school sessions on matters like menstruation. There were good improvements in health knowledge. Women became more empowered regarding their own health and pregnancies. Throughout all work, we encouraged local partners to involve the faith healers as much as possible.

Health post attendance steadily improved until hit by Covid. Child health services including immunisations ran well. It became standard for pregnant women to attend the recommended four antenatal care appointments. With time, almost all local women delivered at the new birthing centre. The few who delivered at home had skilled midwifery support. Also, a small number are delivered elsewhere like at the main Taplejung Hospital, occasionally on referral from the health post and using the Community Fund. Newborns were cared for by midwives in a clean, equipped facility. There were no maternal deaths over this period.

Community Fund Chair Phampa Maya Ra

Despite some disruption at the time, the Nepalese health service reorganisation and the new federal political system with local government at Rural Municipality level, led to significant improvements in our work. We supported with capacity and resources, in local partnerships and in keeping with local structures and policies. This meant that our Yamphudin work was sustainable when completed.

We handed over full responsibility to villagers at the end of 2021. The then Ward Chair, Mr Tashi Lama, listed our many achievements together and said: ‘I feel proud when I hear from others that our health post is one of the best in the entire Rural Municipality. We are fully committed to continuing the awareness raising in the community.’ Ms Pampha Maya Rai, who runs the Community Fund commented: ‘Now I feel so happy that the women in Yamphudin feel confident that they can have their baby delivered here. I hear them say that they want to deliver in the health post here.’

Yamphudin is now a beacon for health care among the remote Taplejung villages and work is underway to roll out lessons learnt to other needy communities there.

Dr Debbie Bartley, Himalayan Trust UK


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