1. Facilitating Synergies to Scale-Up Maternal and Newborn Best Practices in Nepal JR Shrestha, Prof. DS Manandhar, B Thapa Mother and Infant Research Activities (MIRA)

2. Maternal and Newborn Health in Nepal Nepal has very high Maternal and Neonatal mortality rates: – MMR 281/100000 live births – NMR 33/ 1000 live births (NDHS 2006) Most of the deliveries occur at home and majority of maternal and neonatal deaths occur at home Many Studies and programs have been carried out with significant improvement on Maternal and Newborn health These organizations had only few interactions with other organizations engaged in similar activities in the country

3. Purpose Improve maternal and newborn health in Nepal and help achieve MDGs 4 & 5 By facilitating synergies between organizations and relevant government and non government institutions engaged in high impact Best Practices Bring awareness among program managers and other stake holders for scaling up such practices

4. Method MIRA facilitated the synergy between organizations working for maternal and neonatal health in Nepal by organizing: Formation of Steering Committee National level meetings Regional workshops and Exchange visits Follow-up and documentation Dissemination of findings Report writing and Publication (in process) In coordination with Family Health Division, MoH, Nepal Total budget: $ 50,000

5. National level meeting chose Five Best Practiced to scale-up MIRA – Use of participatory women’s groups in improving maternal and neonatal health in Makwanpur district NFHP/ SNL - MINI program for management of sepsis in neonates at community level NFHP - CB-MNC program for preventing postpartum hemorrhage by using Misoprostol in Banke district PLAN - formation and activation of pregnant women’s group for improving maternal and neonatal health in Bara District CARE - improving maternal and newborn health in Kanchanpur district through women’s empowerment

6. M I RA carried out a series of Meetings, Workshops, Exchange visits and Follow up in five regions: Eastern Region Morang Biratnagar Central Region Makwanpur Hetauda Western Region Kaski, Pokhara Midwestern Region Banke, Nepalganj Far western Region Kanchanpur Mahendranagar Participants were Doctors, Nurses, Public Health Officers, Supervisors, District Administrators and Program Officers from Govt., I/NGO and Private Health Institutions Total Participants 189 (Male:105.Fe:84)

7. Impact Studies Pre and post test scores regarding knowledge on maternal and newborn care best practices showed marked improvement We facilitated participation of stake holders from 8 Community Based Newborn Care Program districts chosen by the government This has helped 8 districts where Community Based Neonatal Care program is being implemented

8. Dissemination and discussion Dissemination and discussion were carried out in the VII th conference of Perinatal Society of Nepal (Dec. ‘09) Total participants were 150 (Doctors, Nurses, Public Health workers etc.) Such dissemination have helped more stakeholders to know about best practices in maternal and newborn health  Larger organizations engaged in scale-up of their activities can incorporate some of these best practices into their program with minimal additional cost

9. Challenges Transfer of participants particularly those working in government health facilities has become a major challenge Lack of fund to scale up these practices in other districts has been another important challenge

10. Lessons Learned National network found more effective for advocacy Lobbying among the senior officials and program managers for scale up is important Case studies (e.g. newborn sepsis management) have impressed policy makers and program managers Regional workshops and exchange visits were found to be very educational Follow-up programs were very important for keeping the participants motivated about the best practices

11. Capacity Building This program has brought greater awareness among the participants on the value of five best practices in improving maternal and newborn health in Nepal Workshops and exchange visits helped to bridge the gap that existed among the participants

12. Recommendation Scaling up of this programs in other districts of the country would bring awareness among more health personnel and other stakeholders Field visits are to be arranged for proper observation and later implementation in their districts THANK YOU