Bring healthcare to thousands in rural Nepal

Community Based Integrated Management of Neonatal and Chilhood Illnesses (CB-IMNCI) training program was held in Nilakantha Municipality, Dhadingbesi from 21^st to 25th May. The training was organized by Himalayan HealthCare & funded by CHAO FOUNDATON and TFISH FUND in co-ordination with the District Health Office Dhading, Benighat Rorang, Gajuri & Thakre Rural Municipalities, Dhading and Mahankal Rural Municipality, Lalitpur 

CB-IMNCI program was mainly focused on community based health providers. This program aimed to provide proper education on neonatal, infant and children’s health which could minimize the risk of neonatal, infant and children’s mortality rate and to build the capacity of health works to identify and manage common childhood illnesses.

In Nepal, the mortality rate for children aged 1–59 months is approximately 14 to 17 deaths per 1,000 live births. The broader under-five mortality rate (0–59 months) sits at 31 per 1,000 live births. Over 60% of these early childhood losses occur in the neonatal period (the first 28 days of life). For older infants and children (1–59 months) leading causes for deaths are predominantly preventable or treatable and include:

• Pneumonia (Lower Respiratory Infections)
• Diarrheal diseases
• Severe acute malnutrition (SAM)

The main objectives of this training were:

• To enhance knowledge and skills on assessing/classifying sick newborns and children from 2 months to 5 years
• To improve skills on diagnosis, treatment, counselling and referral practices
• To strengthen follow-up and recording/reporting protocols
• To orient participants on the updated national CB-IMNCI protocols

Participants: 10 Female health providers from Benighat Rorang, Gajuri & Thakre Rural Municipality, Dhading and Mahankal Rural Municipality, Lalitpur parrticipate din the training. the training was conducted by District Health Officer Mr. Bishnu P R and Public jealth Officer Mr. Toyanath C. Mr. Kul MB from Himalayan HealthCare Nepal  facilitated the program.

 Methodology and session covered

The training used participatory method including lectures, group discussion, case studies, demonstrations and role plays.

Day wise summary:

Day 1: Introduction to CB-IMNCI, assessment of young infants 0-2 months, major causes of death among new born, achievement of CB-IMCI/CB-NCP, new born centered services

Day 2: Diagnosis protocol of children under 2 months, registration of diagnosis and treatment plan, Photo presentation and diagnosis of infant (Umbilical cord bacterial infection), classification of umbilical cord bacterial infection on infants, classification and treatment of pneumonia, diarrhea and malaria for children

Day 3: Severe malnutrition, malnutrition diagnosis and treatment protocol, diagnosis of fever and its classification, nutrition status, case study exercise on CB-IMCI OPD register, counseling on breastfeeding, complementary feeding, and danger signs

Day 4: Role plays, case management scenarios, referral protocol, case study exercise on CB-IMCI OPD register, case study on photographs for measles, chickenpox, scabies and anemia, Z-score calculation & Standard deviation, APAC (Acute Post-Acute Care), follow up and counselling protocol according to CB-IMNCI guidelines, food chart for children from 0-5 years

Day 5: Post-test, action plan development, feedback, and closing session

Practical demonstrations and practice on:

KMC – Kangaroo Mother Care: Steps for skin-to-skin contact, positioning, monitoring, and counseling mothers

BAG and Mask Ventilation: Correct use of neonatal bag-valve-mask for newborn resuscitation, including technique, timing, and safety checks

CPAP – Continuous Positive Airway Pressure: Basic principles, setup, indications, and monitoring for preterm/low birth weight babies

 Key Achievements and Outputs

1. Knowledge Improvement: Pre-test scores ranged from 18-26 out of 30. Post-test scores were 28 and above for all participants, indicating significant knowledge gain. 
2. Practical Skills Gained: All participants demonstrated the correct steps for KMC, BAG and mask ventilation, and CPAP setup during supervised practice sessions. This improved confidence in managing sick newborns at the facility level.
3. Skill Practice: Participants engaged in role plays and case studies to practice assessment, classification, and counseling steps.
4. Action Planning: Each participant developed a ward-level action plan for implementing CB-IMNCI practices and follow-up after returning to their communities.

 Challenges and Lessons Learned

Practical sessions with actual patients were limited during the training. Most practice for CPAP, KMC, and BAG and mask was done on mannequins and role plays, which reduced hands-on clinical exposure.

If possible, future trainings should be carried out in coordination with health facility center to schedule supervised clinical practice time on real cases for newborn care procedures.

Conclusion

The 5-day CB-IMNCI training in Dhadingbesi successfully built the capacity of 10 Health providers to manage common childhood illnesses at the community level. With improved knowledge scores and clear action plans, participants are better equipped to contribute to reducing under-5 morbidity and mortality in their wards.

Rapti Municipality in Chitwan District is HHC’s third region where the child nutrition program has been launched after the success of Rubi Valley and Benighat Rorang in the previous cycles. Since the start of the program in May 2024 when 32% of children screened were found to be malnourished, the status in Sep 2025 was down to 11%, Dec 2025 at 9% and at 6% in February 2026. The total number of malnourished children has come down from 427 to 95 which is still a big number but it is half of the national average and better than most municipalities now. 

Time Span               Total                   Severe        Moderate         Mild                                    Total%

Jun-Sep 2024          427                         39                 92                    196                                    32%
Oct-Dec 2024          301                         20                128                   153                                    22%
Jan-Feb 2025          169                         16                 35                    118                                    13%
Sep 2025                 143                         21                 48                      74                                    11%
Dec 2025                 106                         8                   35                      63                                    6%

September 2024 - 1 in 3 children malnourished, 32%
September 2025 - 1 in 10, 11%
December 2025 - Less in 1 in 10, 9 %
February 2026 - 1 in 17, 6 %

The total screening count is at 1559 and the graph shows a steady decline and a surprising amount of progress in spite of the difficulty in working with the government employed local health providers who are short of proper guidance and pressure from the higher authorities and political representatives. There are still issues that need to be resolved to make the program better and stronger before the end of the project in March 2026 after which HHC will monitor and supply supplementary foods for the malnourished children for a year till end of 2026. After our two years of constant monitoring and support, we hope the lessons are well received and the child malnutrition fight is taken up by the providers and the local leaders. 

The child nutrition rehab center needs to be the center for all activities going forward but again the political will and the administrative desire is what will make the difference.