1. Health Promotion in rural Nepal Jane Stephens, Director Green Tara Trust (UK)

3. Purpose of Programme Government policy and health systems change need to be informed by good quality evidence from the field, and vice versa All forms of good quality evidence need to be included- qualitative, quantitative, case studies, lessons learned from implementation of field programmes Create opportunities for dialogue between field, district, national and international level where all are seen as equally valuable.

4. Health Promotion Cycle Health Promotion Cycle Programme Planning Needs assessment Evaluation Implementation

5. Our methods Helping communities find their own solutions to health problems

6. Needs assessment First Phase: (2006) What is the situation on the ground? Available data - GON, university student projects, Gvt. and NGO programmes Community visit, broad FGDs and IDIs- identify main problems Second phase: Needs assessment- quantitative and qualitative Confirm problems, find out WHY problems exist and main players

7. Needs assessment Third phase: Dissemination of findings Fourth phase: Negotiation of community priorities between different groups and who will take responsibility for each part? Young people Fertile Women Mother in laws Fathers Teachers Politicians Health workers

8. Programme planning from Needs Assessment Identified 3 major target areas Improving antenatal attendance & quality of care Increasing womens decision making power around health decisions Increasing number of women having trained attendants at delivery Participatory Action Research: monitoring by community-empowerment & sustainable behaviour change, external monitoring by GTN staff, external evaluation

9. Sketching Monitoring Map in Village

10. Implementation – Main Activities 2 Government trained HW - HP for 10,000 people Reactivation/ formation womens groups Home visits Mass events Training for traditional healers, FCHVs Support to health facilities: goods, mentoring Mobile ANC clinics in areas far from health post

11. Implementation – Resources required People; key community players Skills: training in HP & PRA Motivation to improve own and communitys health Infrastructure: existing buildings, health facilities, empty community buildings Support from main players at ALL levels Transparent & clear health systems with people in post Goods: teaching materials, small incentives Small amounts of money: transport, meetings

12. Implementation – Challenges Previous NGOs providing incentives: hard to change this behaviour How can we encourage environment of positive behaviour change that is sustainable in this environment? Critical thinking and ability to reflect Participation requires some self-confidence and breaking down of hierarchy; and we can only set up environment, people need to take responsibility for their own behaviour How can we set up the conditions for this shift in thinking and behaviour to come about in Nepal?

13. HP in low-resource setting: rural Nepal Greater need and scope of health promotion Advocacy in support of health promotion at all level Alliances & networks Need to move beyond disease prevention approach Paper is freely available on the web: www.healthrenaissance.org.np/uploads/7141_24852_1_PB.pdf

14. Thank you Contact UK Karunamati: doctorjane99@hotmail.com Padmadharini: Director- gttpadmadharini@gmail.com Nepal Green Tara Nepal: Ram Chandra Silwal, Country Director gttn@wlink.com.np