Healthcare & Education in the Hidden Himalayas

Dear Friends and Supporters

Giving birth in Humla is a risky business. Doleni Sunar, a mother aged 46 years, has had 6 children but 2 died. After each delivery she suffered poor health and did not have enough food to keep herself and her child healthy. Traditional beliefs meant she got little or no support while pregnant and only after the birth did family members rally round to help and advise. She is very grateful for the services provided by the Trust and for the way it is improving the local health service and current systems.

2019 promises to be a significant year of change for the Nepal Trust's community health programme and also we hope for the long-term delivery of healthcare into the Hidden Himalayas.

We have recently launched two major initiatives, the longer objective of which is to engage the local communities and local government in taking ultimate responsibility for the sustainable delivery of the community healthcare programme.

The wider catalyst for change has come from the changing horizons in Nepal with, following recent elections, local district governments being given more responsibility and budgets (plus discretionary decision-making authority) for healthcare. The immediate catalyst for change is the support we have received from the Wilde Ganze Foundation in Holland to build 3 new health posts in south Humla District at Maspur, Piplang and Tumcha rural municipalities (RMs).

This is a major project and one in which we engaged with the local government, through the District Health Officer’s (DHO) office in Simikot, in the selection of location and sites for the construction work and, crucially, have agreed that these new clinics once constructed will be adopted as government health posts, effectively replacing old building units that are no longer fit for purpose. Government healthcare workers and Nepal Trust healthcare workers will operate from the clinics, reflecting the model of co-operation that we have already established at our health post in Sarkegad.

Elsewhere we have engaged a local NGO, SHIP Nepal, which is based in Simikot, to take over the day to day management of the delivery of our health programme at the Bargaun, Sarkegad, Kermi, Yari and Halji clinics. Responsibility for the overall strategy and financing of the programme will remain with the Nepal Trust but responsibility for the local management of the programme will be transferred to a local healthcare manager working for SHIP. The NT healthcare workers will also be engaged by SHIP. A key objective and responsibility being transferred to SHIP is that of engaging with the DHO to have the 5 NT clinics in North Humla adopted as community health posts and brought into the local healthcare programme.

We see this transition as a medium-term objective and one that we hope to complete within the next 5 years. In the mean time we remain responsible for funding the healthcare programme that costs in excess of $70000 per annum. Donations to support the programme ensure that the health and wellbeing of those in one of the poorest and most remote parts of the world are catered for and these mountain people can look forward to a healthy and more productive future.

Prajit Bohara, a government Health Assistant in Humla, remarks that many people remain sick due to a lack of services available. Traditional medicine is still the only real option for many and although it may help in some cases lack of basic knowledge is a major stumbling block. He remarks that many more health posts are needed so that already ill people do not have to walk for hours, sometimes days, to reach the nearest health facility. According to Prajit having a health/birthing centre has a positive impact on the community. It raises the status of the village and makes it more active. People become more educated and productive.

The Trust is working with the local government and village communities to provide a working health system that meets local needs. Within the next five years we hope to be able to transfer full responsibility to local authorities but still be able to provide support and encouragement in this most remote and impoverished part of the world. Many thanks for your support and interest and we hope you will continue to help when you can and tell your friends about us. This is not a project for the faint hearted but it is a lifesaver for many.

 Namaste

Dear Friends and Supporters.

 As an INGO the Nepal Trust has strict Nepal government rules and regulations to follow. While sometimes feeling a bit bureaucratic it is sensible to ensure a coordinated approach that meets the needs of the country. The problems of such an ethnically diverse country spread over some of the most difficult terrain are immense. Remoteness is one and the ‘Hidden Himalayas” is typical with no roads or basic infrastructures to help services meet local needs.

The Nepal Trust has just completed a 5year project cycle, and is about to start a new one. Before the old Project Agreement (PA) can be signed off, and a new one agreed, the government must conduct a Final Evaluation Report for submission to the Social Welfare Council (SWC). This has now been completed and accepted by the SWC with excellent results from our point of view.

 The following is a summary of its major findings.

 Overall, projects run by the Nepal Trust are found to be done very effectively and according to the approved project agreement and surveys.

• ‘Community Health/Education, Sanitation and Livelihood Development project’ comprised various sectors including livelihood support for sustainable development, health, sanitation, education and livelihood
• Constructed 8 Health Posts and Birthing Centres that have benefitted 31557 people.
• Constructed school infrastructures including main buildings, retaining walls, fencing, toilets, canteens, classrooms, furniture, school equipment and drinking water at 3 schools.
• Project donor funds have been utilized properly whereby all tax regulations have been followed.
• Internal management is good and the overall effectiveness of the project is very satisfactory.

Effectiveness 

The project has achieved its targets, and appears to have exceeded overall targets that were set before launching the project. The project has focussed on community development programmes mentioned in the project agreement.

 Efficiency

The project interventions are low cost particularly in light of logistical constraints and the remoteness of the area, tangible benefits received by the beneficiaries in terms of increased education, sanitation, energy, development and health of the targeted communities as well as sustainable development. Considering the low cost for administration and project support it seems the Nepal Trust INGO has reached many beneficiaries through its projects. This also became very clear by the positive responses from government officials who supported the fact that activities had been implemented at low cost and had achieved good results.

Coordination and Coherence.

While implementing the ‘Community Health/Education, Sanitation and Livelihood Development Project’ coordination took place with the partner NGO, the communities and local authorities. Every year 2 meetings were conducted with the District Project Advisory Committee (DPAC) as well as various meetings with school management committees, health management committees, teacher/parent associations, local communities, electricity committees, tourism committees, journalists, political parties, government bodies, etc.

Sustainibility.

The Nepal Trust involves local communities in its projects and encourages them to obtain local funding as part of their contribution. This ensures ownership of projects and motivation within communities to maintain their own assets and take care of projects that will ensure sustainability. Projects are handed over to existing community and user committees or those that are set up for the purpose. The Nepal Trust also facilitates communities in local grant writing, subsidy attainment, and creates linkages to local agencies and government bodies to achieve better local cooperation amongst stakeholders for the long-term. The Trust also works with more business like principles to get the best value for money in its projects and as there is a long-term commitment and plan to extend activities and work more closely with the government system so, therefore, the sustainability of this project is very good. Besides this there are some issues also. The evaluation team asked various beneficiaries about the project sustainability. According to the stakeholders there is not enough coordination between the local levels and related education offices about long-term support for the sustainability of the project. However, people hope that the programme will continue for many years to come to help them in their development for which people are willing to take an active and pro-active role in order to achieve this. Through active participation and, by linking to the government system, communities will be better enabled to sustain their projects in future themselves.

 Transparency

For all project activities the respective beneficiaries were informed of project cost to serve the transparency issues. Social audits were conducted on site by local staff management.

 Opportunity

This project has been implemented in a very remote and impoverished part of Nepal’s Himalayas. The project has an opportunity to bring much needed change in Humla district.

 Strength

The project is benefitting deprived communities and addresses the problems faced by the mountain people by integrating education, energy, health and livelihood support in a great manner.

Threat

The project runs in a very remote area where logistic constraints create problems at times for project implementation. There is no road connectivity and often electricity and communication facilities are lacking. Also villages are sometimes located many days walk away from each other and are very much scattered throughout the area.. Weather issues form another challenge. All these factors contribute to higher project costs and make it more difficult to manage projects by local staff.

 Weakness

The logistical constraints and weather issues in the project area can create challenges for successful project implementation.

 Conclusions

The Nepal Trust has exercised vigorously to improve the basic health and education of Humli people. It has constructed health facilities and supported basic medicines and medical equipment to many health posts. Moreover, the credit of school construction to make easy access to primary education for the people of Thehe VDC goes to this organisation. The Trust has played a crucial role to support the health and education sectors in helping to reduce the morbidity and mortality rates. Since the project aims to continue in future years more targeted output can be achieved. The overall performance and financial management of the Trust was found sound and in accordance with Nepal government financial rules and regulations. The financial statement was properly drawn up according to the general accounting principles. Internal control mechanisms were conducted in a sound manner. All the financial transactions and activities were in compliance with the general project agreement and tax laws.

Internal auditing practice is applied. It helped to prepare accounts and to provide a true and fair procurement of goods. Tax is deposited directly to the Inland Revenue office within the time specified by the income tax act of 2058. Quotations, in writing, are collected from potential suppliers by the partner NGO. Overall effectiveness of the project is high considering the value for money achieved and by taking into account the difficult circumstances the organisation is working in. Overall performance of projects run by the Nepal Trust is found to be good and they have reached a significant number of beneficiaries and obtained the required project output. With the analysis and project visit made so far overall financial performance of the project is very satisfactory. Since the project is completed and aims to continue in future years, the targeted output has been achieved and can be increased in years to come. The overall performance and financial management of the Trust was found effective. The internal control mechanism was very good and solid and donors can be assured that project funds are spent properly.

This audit report is an excellent independent commendation of our work under some very difficult logistical circumstances. The next 5year plan has been approved and will be reported on in future reports. In summary we will be carrying out the following projects under our ‘Health and Opportunity’ umbrella.

• We will build 3 new health clinics/birthing centres in south Humla, an area not yet well served by the current system. The clinics will be to approved government design under the control of the District Health Officer (DHO) at Maspur, Tumcha, and Piplang and will serve a population of 12500 people.
• We will continue to support 4 existing clinics and 3 birthing centres.
• We will deliver 4 Little Doctors training courses per annum at Secondary schools in Simikot, Sarkegad, Thehe and Bargaun.
• In collaboration with the DHO we will deliver, each year, maternal health training in Yari, Bargaun and Sarkegad.
• We will continue to promote and develop renewable energy projects in the district through our innovative Renewable Energy Service centre.

To all our donors and supporters I would like to thank you for your support and I hope that the results make you happy and satisfied that your donations have not been wasted. I hope you will continue to help in whatever way you can and please tell your friends. Pass on the good news.

Namaste