Nepal's IEC approach for the integrated project.

PIP: When the Integrated Family Planning and Parasite Control Project (IP) was launched in the Panchkhal area in Nepal, the area had an intestinal parasite incidence as high as 90%. Before the pilot projects were set up, the emphasis was on the IEC aspect. Meetings and discussions were held with the concerned community leaders about the objectives of the integrated project. Pamphlets, posters and booklets were prepared, pretested, printed and distributed. Once the program began, such activities as person-to-person communication, construction of demonstration toilets and protected water sources were started. The primary school was the target and beneficiary of these activities. A mobile laboratory was set up and eggs of parasites were shown to parents and others to stir their interest. The passage of round worms in affected areas and the administration of drugs was a serious concern to some parents. The community was warned that reinfestation could occur in 3 months if personal hygiene was not observed and latrine use was not practiced. The documentary film, 'Ascariasis' provided by JOICEP is one of the most popular and effective mediums for motivating the rural populace to improve environmental sanitation and ensure against infestation and reinfestation by parasite. Other audiovisual methods are also helpful. A local-level cooperation committee is responsible for planning and implementing the integrated project at the local level. Various IEC strategies were used to stress the need to establish a community-based primary health care (CBPHC) unit. The integration of parasite control with family planning has resulted in a marked reduction of parasite infestation in school childred and has increased the acceptance of family planning.^ieng

Making life easier in the rugged countryside through the Panchkhal Panchayat Health Movement.

PIP: Nepal is a mountainous Himalayan country. All the signs of underdevelopment--poverty, illiteracy, sickness, malnutrition, high birth rate, high infant mortality--are evident. Life in Panchkhal is not easy. Women work hard, fetching water from streams or ponds. There are no safe sources of water. Water-borne diseases are common because of fecal contamination of water. Unhygienic habits and unsanitary disposal of human excreta have resulted in a high incidence of parasitic infestation in the community. In 1983, community-based health care units were set up. Community members pooled funds for a community-based primary health care unit where drugs for diarrhea, scabies, dysentry, cough, fever, and eye infection would be made available at low cost. The Integrated Family Planning and Parasite Control Project has set up a sales depot to make drugs available at nominal prices. 2 health units were established in Panchkhal in 1983. There was a strong determination on the part of the community to improve the health status of the people, especially that of the uner-5s. The local village health workers were trained and assigned to work in the project area. Village health workers found the health unit a useful base. The importance of disease prevention was realized by the villagers. At present there are 9 health units. Each is run by 2 village health workers who receive salaries from either the integrated project of the government FP/MCH program. Social workers also provide services. A woman volunteer trained in basic MCH and family planning motivation assists the unit twice a week. The responsibility of the health committee is to ensure the smooth operation of the unit and to see that health care is provided to the villagers. Toilets have now been constructed in many homes. Children are healthier. Family planning is more acceptable to the community. The marketing of lacal produce is a problem, as well as funding of the health project.^ieng

Barriers to effective family planning in Nepal.

To investigate why family planning (FP) services in the Kathmandu Valley of Nepal are underused, a study was initiated under the auspices of the Nepal Family Planning/Maternal--Child Health Project. The study was intended to provide a user perspective, by examining interactions between FP clinic staff and their clientele. "Simulated" clients were sent to 16 FP clinics in Kathmandu to request information and advice. The study revealed that in the impersonal setting of a family planning clinic, clients and staff fall into traditional, hierarchical modes of interaction. In the process, the client's "modern" goal of limiting her family size is subverted by the service system that was created to support this goal. Particularly when status differences are greatest, that is, with lower-class and low caste clients, transmission of information is inhibited.

PIP: To investigate why family planning (FP) services in the Kathmandu Valley of Nepal are underused, a study was initiated under the auspices of the Nepal Family Planning/Maternal Child Health Project. The question behind the study was whether the professional providers of family planning services are themselves inhibiting effective use of contraception. The purpose of the study was to examine interactions between family planning clinic staff and their clientele. For this purpose, 6 couples and 2 individual women with different socioeconomic backgrounds posed as clients (simulated clients) and were sent to 16 of the 25 family planning clinics in the Kathmandu Valley over a period of about a month. The simulated clients were trained individually and as couples, using role-playing techniques and acting out roles that did not deviate much from their actual life situations. 3 groups of simulated clients with different taste, class and educational backgrounds were trained and sent to nearby family planning clinics. Group A consisted of 2 high caste, urban couples. Group B consisted of 2 lower middle-class couples and 2 individual women. The 2 couples in Group C were lower-class. The accounts provided by the simulated clients were analyzed qualitatively for overall content, and rated using a scale of 1 through 3, based on the accuracy of the family planning information provided, attitude of the staff toward the client and bias of the staff toward the client. The underlying assumption was that a good attitude and lack of bias on the part of family planning staff would be conducive to a desirable outcome, that is, a well-informed, free decision by the client to adopt a particular family planning method. Directly and indirectly, the study revealed a number of barriers to provision and effective use of family planning services in the urban areas of Nepal. The scores indicate that the family planning information provided at most clinics is inadequate or incorrect in many cases. The manner in which the information is presented is apt to drive clients away. In the impersonal setting of a family planning clinic, clients and staff fall into traditional, hierarchical modes of interaction. Moreover, the quality of the services was positively related to the socioeconomic status of the client. Unsophisticated lower-class clients are likely to receive scantier, less accurate information and less courteous treatment than educated middle-class clients. The former's negative perceptions of family planning and family planning clinics probably become disseminated among friends and neighbors. A neighborhood-based program would be more effective than the clinic-based system as it now functions. An alternative or complementary program might focus on upgrading the communication skills of family planning staff within clinics.

Early childhood experience in Nepal: a study of sickness, treatment and mortality.

This article reports on a longitudinal study of almost 7,000 children under six years in selected villages in Nepal, giving their morbidity and mortality history, treatments given and costs involved. The study suggests that about two children out of three are defined as sick by their mothers in any given year and that treatment is sought for about 40 percent of sickness in small children. Three of four children treated are treated by scientific medicine, that is by physicians, nurses or pharmacists. The principal causes of death are fevers and diarrhea. Education of mothers in spacing of births, hygiene, nutrition and rehydration therapy would appear to be the most important primary health care service, along with increased access to potable water and to medical clinics.

Socio-educational influences on nepali women and their association with innovative values and behaviors.

The introduction of health and family planning services in developing countries often requires extensive changes in the values and behaviors of the women of those countries. A better understanding of the factors influencing change in rural women would provide a stronger scientific base for the introduction of health services.The authors gathered data from 1,417 rural women in Nepal. Indicators of social change were contraceptive use, desired family size and scientific treatment of sick children. Major influences associated with change were regionality, having children in school, ownership of money and access to media. However, the strength of association with the indices of change varied, suggesting that change in values and behaviors is meaning specific and not a general phenomenon.