Featured Grantee Fact Sheet


Mission

In the districts of Baglung and Dolpa, an average 11,000 births occur annually.

In Nepal, 90 percent of pregnant women deliver their babies at home. The poorest families have no access to prenatal care or any Skilled Birth Attendant (SBA) to help them through the delivery.

Every day 12 Nepali women die in childbirth, nearly half of them needlessly bleeding to death. And even when a new mother does survive, odds are that her baby will not. Every day, 75 Nepali infants take their final breath, most of them less than a day after birth.

“Every mother deserves a baby to cradle, not a tiny body to bury.”

The mission of One Heart World-Wide is to improve the health and wellbeing of pregnant women and newborns who may not otherwise have access to medical or public health services due to cultural barriers, limited personal resources and living in remote locations.

One Heart recognizes that in order to make a lasting impact, all of its programs must be sustainable, culturally relevant and build the capacity of local people to prevent pregnancy and childbirth-related deaths not only for this generation, but also for those to come.

One Heart has created the Network of Safety program to improve the lives of women and newborns during pregnancy and childbirth in two remote rural areas of Western Nepal.

The program includes health provider training, health education, birthing related materials and community outreach programs to ensure that pregnant women and their newborns have access to necessary care to survive pregnancy and delivery. This proven, successful program provides community educational visits, vitamin supplements, birthing kits, and cell phones for emergency labor situations.

DFW’s $50,000 grant to One Heart will continue the Network of Safety program by funding training for 800 women as Community Health Workers who will each reach an average of 10 pregnant women annually. The grant also covers the cost of 2,000 birthing kits. More than 7,750 women will be directly affected and indirectly another 39,000 may be reached (the number of women of reproductive age that should be impacted through increased awareness and education through their community outreach providers, peers and community members).



Life Challenges of the Women Served

In this beautiful and remote area of Nepal women have many challenges, as they do in the rest of the developing world.  While cities have modern hospitals and birthing facilities, in Baglung and Dolpa districts most deliveries are home births accompanied by local women, usually untrained.  Most women have no pregnancy-related contact with modern health services and maternity services are both under-utilized and low in quality.

Traditions and cultural beliefs can also impact the birthing process in these rural regions. Birthing centers are rarely an option for most women.  Considered unclean because of the blood and mess, birthing is typically not allowed in the house.  The same is true of menstruation, when women must move into a shed for the duration of their cycles.

Therefore, births may take place under dark, unsanitary conditions.  Community members without formal training who often
assist in births can unwittingly cause harm due to a lack of education on safe
birthing practices or warning signs of complications.

It is also believed the naming ceremony, which may be days following the birth, brings milk to the mother’s breasts.  The importance of the naming ceremony challenges the health of mother and child because mothers do not breastfeed their babies until after the ceremony. As a result of such practices, maternal and newborn mortality is high.

 



The Project

In Tibet, One Heart developed an effective, replicable and sustainable model to reduce preventable deaths related to pregnancy and delivery among vulnerable rural populations. The programs work with local communities and local health providers to develop a culturally appropriate Network of Safety around mothers and infants, by raising awareness, teaching good practices and distributing essential supplies to ensure that mothers and infants survive delivery and the first months of life. The Network of Safety is innovative in that it is tailored to the local cultural context, it puts the mother first and program interventions are aimed simultaneously at several different levels to ensure appropriate continuity of care for the mothers and infants.

Program Goal – The goal of the program in Nepal is to implement the Network of Safety to surround mothers and their newborns in both Baglung and Dolpa Districts.  The Network of Safety includes training of outreach health providers in local communities; training skilled birth attendants at the health-post level, and training of hospital staff at the referral center level.

Health training of outreach providers – One Heart master trainers will conduct three training sessions monthly for one year, for Female Community Health Workers (FCHW) to become One Heart outreach providers (One Heart calls them “foot soldiers”).  Each session includes 10-15 trainees and be led by two master trainers.  Each outreach provider will be expected to attend two to three training sessions to ensure proper training coverage.

The focus of the training is on enabling the health providers to effectively handle:

• Health during pregnancy and birthing – outreach provider will learn about a large variety of important maternal and newborn health topics to make them more aware of potential dangers to mothers and newborns.

• Hands-on skills for emergency home births that can make home birthing safer for mothers and newborns.

• Distribution of pregnancy and birthing supplies including cell phones for emergencies, maternal supplements and Safe Birth Kits for distribution to the pregnant women they are serving.

• Effective community outreach skills including the use of appropriate training aids, teaching skills and techniques.

• Accurate data collection (for program evaluation).

Each trainee receives a backpack containing basic outreach, medical and birth supplies including maternal vitamins, Safe Birth Kits and educational materials.  The skills to manage and distribute the supplies are taught in the training program.

 

Community outreach – Outreach providers will be expected to use the knowledge and skills they have acquired to help pregnant women and families who live in their area.  They are expected to identify pregnant women and make four home visits at prescribed intervals during the course of the pregnancy, both to monitor the pregnancy and to provide safe pregnancy and birth training to the pregnant woman and her family members.  The final visit is to be made soon after delivery to check on the progress of mother and infant and be able to intervene if problems exist.

Local Collaboration – One Heart collaborates with two local NGOs (SWAN in Baglung District and Dharma Karma Society in Dolpa District) which help implement the Network of Safety locally based on Memoranda of Understanding. One Heart provides the technical expertise and the partner organizations facilitate the field implementation of training sessions.

Program assessment/evaluation – Trained outreach providers gather and record information regarding the women they reach and report back to One Heart.  Field personnel maintain detailed records on program processes and outcomes under the supervision of two public health experts in the US.



How the Grant Will be Used
One Heart World-Wide Network of Safety DFW Budget Expense
Program staff (four full-time master trainers for 12 months) $25,220
Training and travel costs – food, lodging and transportation for 800 trainees $20,000
Equipment and supplies – training supplies (demonstration models and printed materials)
and the purchase of 2,000 birth kits		  $ 4,780
Program Total $50,000

 

Please note: Net donations over the grant amount will be reserved to ensure we fund in full all future selected program grant requests, provide Sustained Program Funding to former DFW featured programs, and to offer up to $30,000 to an organization selected by member voting through the new Member Choice Program.



Why We Love This Project/Organization

We love this program because childbirth in remote areas is life threatening to both the baby and the mother, and One Heart World-Wide’s Network of Safety program has already saved the lives of thousands of mothers and their newborns in Tibet, partially through DFW’s three previous grants, totaling $31,712 over three years. In Nepal’s Baglung District, less than 19 percent of all births take place with the assistance of a skilled birth attendant and less than five percent in Dolpa District. We love the community-focused approach, fostering community empowerment and engagement of paid and volunteer health workers.



Evidence of Success

The Network of Safety program was implemented first in Nepal in the Baglung district in 2010.  The year the program started, there were 7,771 births, 31 maternal deaths, and 301 infant deaths providing a maternal mortality rate of 399/100,000 live births and a neonatal mortality rate of 39/1,000.  During the second year, the maternal mortality rate dropped to 360/100,000 and the neonatal mortality rate to 37/1,000.  By the third year of the project, the maternal mortality rate had dropped to 187/100,000 live births and the neonatal morality rate to 21/1,000 live births.

Over the short term, the program improved knowledge, attitudes and skills related to maternal and neonatal health care.  Over the medium term, more women sought appropriate maternal health care, more health care workers appropriately referred and managed obstetric and neonatal emergencies and the relationship between government and the community improved as families realized the benefits government health facilities could provide. In the long term, the result is decreased mortality of mothers and infants.



Voices of the Girls

• “I have two babies. I delivered the first baby at home and there was nobody to help me. I was scared and had prolonged labour. But FCHVs took me into the birthing center for the second delivery, and the baby was born in the birthing center with the help of an SBA. I was comfortable and felt safe at birthing center.”  Shova Darvi, 26

• “After receiving training from One Heart’s Master trainer, I was able to save a baby daughter of Sapana Chhetri, by doing mouth-to-mouth resuscitation and baby was referred to hospital.  The baby survived and is doing well.”  Bhima Devi Sharama (FCHV)

• “I was able to manage shoulder dystopia when a woman was in prolonged labor and the referral hospital was too far and it was not possible to send her at last moment.  The baby survived and I feel that I am able to a save life.”  Kalpana Sapkota (SBA)

• “It’s not uncommon for babies to die from basic things like not cleaning their mouth out to breathe. In surveys we’ve done, more than 50 percent of babies that died were born alive. This is due to lack of education.”  Arlene Samen (Founder – One Heart World-Wide)

 

“It is women who give life; women should not die giving life.”  White Ribbon Alliance



About the Organization

Founded in 1998 by Arlene Samen, the organization works with disadvantaged communities to raise awareness and teach safe birth practices.  In the ten years that One Heart was active in Tibet, the number of women who died in childbirth annually dropped from 33 to zero in the counties where One Heart was active.

Samen was inspired to go to Tibet to help save women and newborns by the Dalai Lama in 1997.  The Clinton Global Initiative has recognized Arlene for her work with women and newborns in developing countries. She has also been named a CNN Hero. Watch her TEDex Talk

One Heart manages close to $1 million in donations to support maternal-child health programs in China, Mexico and Nepal.



Where They Work

The Network of Safety project funded by DFW is located in Western Nepal in the districts of Baglung and Dolpa.  The population of these districts consists of nearly 400,000 people living primarily in rural communities in the foothills of the Himalayas.

Dolpa is an extremely remote and rural area bordering Tibet. The nearest road is ten days walking distance and there are no regular flight connections. It is one of the least developed areas in the world, where people lack access to basic health services, infrastructure, education and electricity, mostly due to the difficult terrain, with elevations up to 25,000 feet.

A large portion of the district is protected by Shey Phoksundo National Park. (The name is derived from the 12th century Shey Monastery and the deepest lake in Nepal, the Phoksundo Lake, both of which lie in the district.)  According to Wikipedia, this district, despite being the largest in area in the nation, had only one vehicle as of November 2012 and no road links to other districts.

The east and south of Dolpa are surrounded by the mountain ranges.  Trekking to Lower Dolpa offers a remarkable and breathtaking experience of a lifetime. The notable features seen here are snowy peaks, ancient and remote villages, rich wildlife, lovely Buddhist monasteries and wonderful lakes. The people of this area are simple and warm-hearted with an enthralling culture and traditions. The cultural traditions of this area are basically linked with the Tibetan culture.

Baglung district is smaller, with an area of 390 square miles, but more populous with 268,613 people housed in 59 Village Development Committees and one Municipality. It is known as the district of suspension bridges because of its many rivers and bridges. It is a hilly district with most of the population settled on the sides of the rivers. Fertile plains situated on either side of the rivers are used for farming.  The district is rich in herbal medicine plants.  Rice, corn, millet, wheat and potato are the major crops. Raw roads connect the villages, and only a small part of the district is electrified. Recently, telephone has been accessible in almost all villages according to Wikipedia.

Reflective of all of Nepal, Baglung and Dolpa are diverse in religion, culture, ethnicity, altitude and temperature. Hinduism and Buddhism are the major religions.



Source Materials
  • Documentation and images provided by One Heart World-Wide to Dining for Women
  • Samen, Arlene, “Saving the Lives of Mothers and Newborns in Remote Areas of Nepal” TheHuffingtonPost.com, 4/20/12
  • Politics / Economy / History / Geography:  Wikipedia