Maternal health and newborns’ survival are priorities for the Government of Nepal, as demonstrated by annually increased domestic funding contributions to these issues and scaling-up of services. The Safe Motherhood Programme is led by the Ministry of Health and Population. To ensure effective use of resources, the Safe Motherhood Plan (2002-17) is being implemented within a Sector Wide Approach (SWAp) framework.
The government has announced free delivery care for all women across the country and is gradually increasing access to services, especially for poor and vulnerable women. The Ministry of Health and Population is preparing to establish a social inclusion unit and has developed a Gender Equity and Social Inclusion Strategy. The Strategy largely focuses on developing patient-friendly health services and increasing access to services, especially for women and children from poor and marginalised groups. Donor assistance is provided for human resource development, service strengthening, infrastructure, procurement, monitoring and research, and for a national financial incentives scheme.
Engagement of community-based organisations in the Safe Motherhood Programme has increased over the past few years. A national alliance of organisations working on the issue has been formed and is working together with the government. Civil society has been instrumental in “capturing voices” of the poor and excluded; building synergies; facilitating dialogue between rights holders; and, providing data and information to support policy reform. Also, a component of the Safe Motherhood Programme, funded by DFID, focussed on equity and access of the poor and socially excluded. It is managed and implemented by ActionAid and its local civil society partners.
One of the outputs of the overall health sector programme is partnerships with the private sector and community-based organisations to increase access to service delivery. While progress seems to be modest at this stage, strengthened involvement of community-based organisations in the health sector, including in the Safe Motherhood Programme, is encouraging.
Advocacy and accountability for safe motherhood and neonatal health have been assisted by women becoming more informed, empowered and organised, as well as by the increased acceptance by local government officials and health workers of the legitimacy of the approaches used – particularly in the light of Nepal’s new “inclusive” political context. Quantitative data showing the extent of service exclusion and qualitative “voice” data, telling many of the stories behind the figures, lends compelling weight to advocacy and accountability initiatives.
Soon to be published data on knowledge, attitudes and practices and service utilisation in intervention areas suggests improvements in both advocacy and accountability, including a positive impact on the availability and quality of services.
The original version of this case study was used to demonstrate ownership in the report “Key messages and case studies for the HLF-3 roundtables from the workshop on “Strengthening the development results and impacts of the Paris declaration on aid effectiveness through work on gender equality, social exclusion and human rights”, London, 12-13 March 2008”. It was prepared by the DAC GOVNET’s human rights task team.