The government will expand the distribution of Matree Surachhya Chakki (tablets to stop bleeding after child delivery) to women in their eight months of pregnancy to 15 districts where there is little access to health facilities, said an official at Ministry of Health and Population (MoPH).

So far, the tablets are being distributed in six districts — Dang, Sindhuli, Jumla, Doti, Bajhang and Mugu — after the programme yielded positive response in the pilot scheme in Banke district in 2008. The districts where the tablets will be distributed have not been listed yet.

“A large number of women in Nepal still die of excessive bleeding during childbirth as they do not avail of healthcare facilities during pregnancy and delivery,” said Dr. Silu Aryal, Senior Consultant Obstetrician and Gynecologist at the Family Health Division. “Women should take this tablet immediately after delivery. This would at least prevent them from dying due to excessive bleeding, even if they do not visit a hospital.”

She also said that the tablet was not a licence for women to deliver children at home. Women health volunteers will visit every month and counsel pregnant women as to which hospital to go to for safe delivery, what sort of diet to take during pregnancy, among others, and provide this tablet when the women reach eight months of gestation, in case they give birth on way to hospital or at home.

According to Dr. Aryal, a pregnant woman should visit a health facility at least four times – namely, during the fourth, sixth, eighth and ninth month, respectively.

However, according to a report of the MoHP, of the estimated 800,000 pregnant women across the country each year, only 50 percent of them visit health facilities in the fourth month. Further, only 29.4 percent of pregnant women complete the full course of the ante-natal scheme. As a result, at least 2,000 women die every year from pregnancy complications, and every year at least 30,000 infants die before they get to be one month old.

According to the Family Health Division, approximately 75 percent of the deliveries take place at home.

The Maternal Mortality and Morbidity Study (2008-09) undertaken by the Family Health Division of the Department of Health Services shows that maternal mortality and morbidity ratio had come down from 539 deaths per 100,000 live births in 1998 to 281 in 2006 and 229 in 2009. Nepal has to reduce the maternal mortality and morbidity rate to 134 by 2015 to meet the Millennium Development Goal (MDG).

With a view to increase access and provide quality healthcare to the country’s urban poor, the Ministry of Health and Population (MoPH) has readied the National Urban Health Policy (NUHP), beginning this fiscal year.

The five-year policy aimed at providing accessible, affordable and reliable primary healthcare facilities to people living in town was prepared jointly by the Ministry of Local Development and MoPH. Both the Ministries will jointly launch urban-poor-centred programmes as per the policy for the period 2010 to 2014.

Despite the fact that there is the highest concentration of doctors and health facilities, the poor in urban areas are deprived of basic health services, according to Dr. Bhim Singh Tinkari, chief of Primary Health Care Revitalisation Division, under Department of Health Services.

“Therefore, MoHP is introducing this policy to delivery primary health services to poor people in 58-municipalities across the country,” said Dr. Tankari.

He also said that Child Health Division under Ministry of Health and other organisations assisting health services namely World Health Organisation, United Nation Child Fund (UNICEF) had often raised concern for not being able to outreach of immunisation programme among urban poor due to lack of clear policy and structure reaching to them.

As per data provided by MoHP, in 1981, of the total population of the country the urban population was 6.4 percent, whereas the population in 2001 reached 13.9 percent.

Of which 25.2 percent of the total urban population are poor. Similarly, the 45.6 percent of urban households have no sanitary system and 55 percent have no appropriate garbage disposal system.

At least 4.3 million populations of 58 municipalities (15 percent of the total population of the country) including in Kathmandu, Lalitpur and Bhaktapur, covering 43 districts do not have luxury of receiving preventive and primary health care services provided either free to the rural population, according to official at MoPH.

Under the Free Essential Health Care Services, the government has been providing 40 essential drugs at district hospitals, 32 at health post and 22 at sub-health posts since 2007.

According to NUHP, each ward will have at least an Urban Health Centre and one urban health volunteer. Similarly, the centre will procure free essential drugs as provided in sub-health post in rural areas.

“The services of the centre mainly will focus on poor, marginalised slum population and population living in squatters living across 58 municipalities of the country, emphasising on immunisation, leprosy, polio,” said Dr. Tankari.

DEV KUMAR SUNUWAR
KATHMANDU, AUG 09-

Breaking away from the tradition of marking the International Indigenous Peoples Day with ritualistic cultural parade, Nepal Federation of Indigenous Nationalities (NEFIN), an umbrella body of indigenous peoples, has decided to use the occasion this year to put pressure on the politicians. NEFIN has unveiled a month-long agitation programme to press for the rights of indigenous people in the new constitution. The protests include a nationwide torch rally on Aug. 14 and blockade of all the entry points to the Capital the following day.

“We have now realised that unless we exert pressure on the political leadership and the government to promulgate the constitution on time with the guarantee of the rights of the indigenous people, marking indigenous people’s day is meaningless,” said Raj Kumar Lekhi, chairperson of NEFIN. “Therefore, we decided to stage protests instead of taking out a cultural parade.”

Nepalese indigenous people, who constitute more than 38 percent of the country’s population, fought for social, cultural and religious identity in the past. Now, they are fighting for their rights, said Lekhi.

He added that NEFIN has been demanding full and effective participation of the indigenous peoples in the decision-making processes, besides a guarantee of several other rights.

Government officials, however, say the state has already fulfiled both international obligations and indigenous people’s demands by ratifying the International Labour Organisation’s (ILO) Indigenous and Tribal Peoples’ Convention 169 on Sept. 14, 2007 and by adopting the UN’s declaration on the Rights of Indigenous Peoples in the same year. The government, with the coordination with the Ministry of Local Development, has already

prepared a national action plan for the implementation of the ILO Convention 169.

Nevertheless, the implementation remains tall order. Sociologist and indigenous rights activist Krishna Bahadur Bhattachan said, “Although ratification of the international conventions relating to indigenous people’s rights is a welcome step, it would be meaningless unless those commitments made in the international forums are reflected in the country’s constitution and government’s plans and policies.”

If the government fails to transform its pledge into a practice, indigenous people’s peaceful protests could turn violent, he cautioned.

Meanwhile, speaking at a corner meet organised by Association of Nepalese Indigenous Journalists, Lekhhi said indigenous peoples’ movement was to ensure their rights in the constitution.

Addressing the meeting, lawmaker and former NEFIN Chairman Pasang Sherpa said that the existing political deadlock put the issues of backward and excluded groups on the back burner. “Therefore, Madhesi, Dalit, indigenous people have to work in unison to pressurise the political leadership to end the impasse and concentrate on constitution writing,” said Sherpa.

The Department of Health under the Ministry of Health and Population is launching a mop-up campaign against polio on Aug. 14 and 15, targeting the children below five years of age in 18 districts, including Kathmandu, Lalitpur and Bhaktapur.

Such a move is a sequel to the detection of five polio cases in Mahottari and Rautahat districts this year. This new campaign is the third one in just two weeks.

Such a campaign featuring door-to-door immunisation programme is rolled out when the polio virus starts transmitting quickly among many individuals, according to Rajendra Prasad Ghimire, senior public health officer at immunisation unit under the Department.

Of the total five polio cases recently, one was seen in Mahottari and four in Rautahat. Increasing cases of polio has not only shocked health officials working for its eradication, but also have dampened the government’s commitment to meet its goal to eradicate polio from the country by 2012.

Acting on the call of the World Health Organisation (WHO), the government first had targeted to eradicate polio by 2002, later by 2005 and lastly by 2012.

“But the rapid transmission of the polio viruses has struck the government’s goal to meet the commitment,” said Department’s immunisation programme chief Krishna Bahadur Chand.

On 21 Feb. this year, the first polio case was detected on five-year-and-eight month-old Rameswore Mandal in Mahottari.

Polio cases were also detected on two-year-old Gupharana Khatun of Rautahat on May 4, on two-year-and-two-month-old Priyanka Yadhav on May 29, on eight-month-old Mohamad Sajit of Rautahat on 9 June and on eight-month-old Sanjida Khatun on 12 June.

Following the detection, Nepali and WHO surveillance medical officers as well as medical officers are working days and nights to contain the virus, said Chand.

According to officials, all the five cases had P1 type of polio virus, which is considered less communicable compare to P3 type. While three of the cases were transmitted locally, the remaining were communicated from the Indian state of Bihar due to frequent border movement. Bangkok-based National Institute of Health has also confirmed this.

Earlier to this, all polio cases entered Nepal from bordering Indian states of Bihar and Uttar Pradesh. Of all the three types of polio, P-3 had been detected in the country in 2000. The last original case of P-1 was found in 1999. The P-2 type has been eradicated from Nepal.

When polio viruses were detected the districts had ran out of vaccines. The rapid transmission of the virus has prompted the health department to expand the immunisation programme in 18 districts.

In the first and second rounds of vaccination drive, the Department distributed vaccines only in eight districts—Saptari, Siraha, Sarlahi, Dhanusha, Mahottari, Rautahat, Bara and Parsa.

In the third round, it is distributing vaccines in 10 more districts—Kathmandu, Bhaktapur, Lalitpur, Chitwan, Makawanpur, Udayapur, Sindhuli, Morang and Sunsari from Aug. 14-15.

POLIO CASES IN NEPAL

Year No. of cases Detected in

1999 2 cases (Type P1) Banke, Saptari

2000 4 cases (Type P3) Siraha, Mahottari, Dhanusa, Rautahat

2005 4 cases (Type P1) Sarlahi, Rautahat

2007 5 cases (Type P3) Siraha, Dhanush

2008 6 cases (Type P3) Rautahat, Sarlahi, Dhanusha, Bajura,

Bardiya, Rupandehi

2010 5 cases (Type P1) Mahottari, Rautahat

Nine major donor agencies, which earlier had suspended financial assistance to a major education project in the country, have decided to continue with their support.

The donor agencies- the World Bank, Asian Development Bank, Department of International Development (DFID), Denmark, Finland, Norway, Australian Aid International, European Union and UNICEF-a month and a half ago had said that they would suspend grant assistance to School Sector Reform Programme (SSRP) after corruption at the highest level in the Ministry of Education (MoE) surfaced.

SSRP implementation, the biggest reform plan introduced in the country’s education sector in the last 39 years, was bound to fall into the abyss after the donor agencies decision to halt their assistance, which amounts to US $ 525 million, of the total cost of US $ 2,626 million for the SSRP implementation from 2009 to 2014.

The decision to continue the support came after the government expressed its commitment to keep an eye on irregularities and action against those involved in the corruption.

“The Danish Embassy, the focal agency of nine donors, on Wednesday has sent a formal letter stating the agencies will continue their financial support,” said MoE Spokesman Lekhnath Paudel

Former education minister Ram Chanra Kushwawha’s name was at the top for embezzling the donors’ money. Despite parliamentary Public Account Committee (PAC) recommendation, the government has not initiated action against Kushawaha. The House panel had said the former minister was involved in irregularities while appointing teachers under relief quota and purchasing materials for the state-owned Janak Sikshya Samagri Kendra Limited that prints government school textbooks.

Following the donors’ decision to suspend assistance, the government had formed a three-member committee to investigate into the irregularities.

The government later removed Kushawaha and appointed Sarbendra Nath Shukla as the education minister. Kushawaha however has denied corruption charges.

“The nine donors have jointly decided to continue their support, after the government committed to taking action against those involved in corruption as per the recommendation of the probe committee,” said senior programme officer at the Danish Embassy, Shiva Bhusal. “But, a formal announcement to this effect will be made in a day or two.”

Private schools in Kathmandu Valley have decided to hike the fee by 25.22 percent from this academic year, beginning April 15.

A decision to this effect was reached during a meeting between Fee Determining and Monitoring Committee under the Ministry of Education (MoE) and proprietors of boarding and private schools late on Sunday. However, the decision will not be applicable outside Kathmandu.

With the decision, each guardian of students studying in private schools have to pay Rs. 300 to Rs. 700 more.

School owners justify the fee hike saying that the move was taken “to adjust salary, allowance and facilities of teachers and staffers as per the market price”. However, guardians and teachers are not buying that argument.

“Private schools hike fees every year on the ground that they would increase salary to teachers. But, they do not act on their commitment, said Hom Kumar Thapa, president of Institutional Schools’ Union. “The worst is 95 percent of the schools have not given the appointment letters to staff.”

On the other hand, guardians said they would adopt a wait and see approach. “School owners have again commited to provide basic salary to teachers in line with the government scale. Thus, we will wait and see until the beginning of new academic session,” said Suprabhat Bhandari, president of Guardians’ Association Nepal.

The umbrella body of private schools has a response. “All schools will guarantee teachers’ basic salary as per the government scale and provide appointment letters to all,” said Gopal Acharya, president of Private and Boarding Schools Organisation in Nepal. There are nearly 900 private and boarding schools in Kathmandu Valley.

The Ministry of Health and Population (MoHP) is all set to scale up the medical abortion (MA) services across the country following the success of a pilot programme in six districts.

After the strategic plan for medical abortion was approved in November 2009, MoHP provided necessary training to health professionals of the 293 government-authorised hospitals, nursing homes and clinics to carry out the services.

“The success result of the pilot programme was 96 percent, so we are planning to expand the services,” said Dr. Indira Basnett, country director of IPAS, an INGO, which advised MoHP on providing safe abortion services. However, the services are yet to reach women at the grassroots level mainly due to lack of awareness, education and communication,” added Dr. Basnett.

The eight-month pilot programmes launched in December 2008 were implemented in 32 health institutions of six districts–Chitawan, Dhading, Surkhet, Kailali, Lamjung, Jhapa–where Comprehensive Abortion Care (CAC) and Comprehensive Obstetric Care (COC) services were available.

“Medical abortion services will simplify abortion, increase the rural women’s access to abortion and provide choices on quality abortion care,” said Dr. Basnett.

Abortion–upon request during the first 12 weeks of pregnancy–was legalised in the country in September 2002 through an amendment to Nepal Civil Code. If the mother’s life is in danger or in cases of rape, incest and foetal impairment, pregnancy up to 18 weeks can be terminated. Such abortions must be carried out at the hospitals or clinics run by MoHP-certified doctors.

As of June 2009, according to MoHP data, more than 331,000 women opted for abortion since the inception of the services.

The recently formulated strategic plan for medical abortion services has provisioned that only the government will be allowed to procure medicine to conduct abortion and health institutions certified for the safe abortion are only permitted to execute the services.

The Department of Drug Administration (DDA) has been authorised to distribute the required drugs and has approved Mifepristone and Misoprostol for medical abortion. MoHP logistic division will import these medicines.

“More lives could be saved through medical abortion services in rural parts of the country,” said Dr. Silu Aryal, senior consultant obstetrician and gynaecologist at Family Health Division.

Officials at JEMC-a government-owned corporation responsible for printing and supplying of school textbooks-have warned that they would stop supplying books if the government failed to increase the prices.

About 85 percent of books have already been printed for the next academic session.

“JEMC in the last 10 years has incurred loss to the tune of Rs. 200 million as the government has failed to adjust the price,” said Birendra Kumar Das, Managing Director of JEMC. “If the government fails to adjust the prices this year also, JEMC will have an additional loss of Rs. 400 million. We are not in a position to take chance.”

Prices for the textbooks were set at Rs. 0.21 to Rs. 0.26 per page in 2000. But there has been no price review in the last 10 years. JEMC officials said it was unwise that the government has not reviewed prices even though costs of raw materials-paper and ink-and transportation charges have gone up by as much as 200 percent.

According to Das, JEMC since 2007 has been sending proposals to MoE seeking increase in the prices by Rs. 0.31 to Rs. 0.32 per page. But there has been no headway.

According to MoE, there are more than 7.2 million students studying in 31,000 schools across the country. About 300 million copies of textbooks are required for grade one to eight. JMEC has already printed and supplied 240 million copies to its Regional Distribution Centres.

Not only MoE, even Guardian Association Nepal (GAN), an umbrella organisation of the guardians, has also stood against the JMEC demand to hike textbook prices. “There should be extensive deliberations among the stakeholders including students and us guardians before the government takes any decision to hike the prices,” Suprabhat Bhandari.

However, Education Secretary Deependra Bikram Thapa said the government two years ago had decided to increase the budget for printing the textbooks and it was mentioned in the budget speech also. “But there are some legal procedures which will soon be resolved,” said Thapa.

A majority of schools have proposed such fee structures without consulting the school management committee, according to a source.

As per the Fee Determining and Monitoring Committee (FDMC) under the Ministry of Education (MoE), ‘C’ grade schools up till higher secondary level can charge maximum Rs. 1,000, while the fee for grade ‘A’ schools should not exceed Rs. 1,900 for the same level. But most schools have proposed a fee structure over Rs. 1,500, even for the primary level.

According to the MoE source, proprietors have been proposing increased fee structure at every FDMC meeting.

For instance, at the meeting on March 13, Pathsala Nepal proposed Rs. 1,050 monthly fee for primary level and Rs. 1,100 for lower secon-dary level and Rs. 1,150 for higher secondary level. At the meeting on March 18, it again proposed Rs. 1,500, Rs. 1,800 and Rs. 1,900 fees for the respective levels.

Subsequently, Xavier International had proposed Rs. 1,100, Rs. 1,700 and Rs. 1,950 for these levels at the first meeting, but later it increased the fees to Rs. 1,800, Rs. 2,100 and Rs. 2,450 for the respective levels.

Although boarding schools say the fee hike is to provide more facilities and salaries for teachers and staff and meet expenses, teachers and guardians are against this logic.

President of Institutional Schools Teachers’ Union Surendra Sharma said that school proprietors are trying to cheat students and guardians. “Ninety-five percent of boarding schools are yet to give teachers their appointment letters. Neither do they pay adequate salary nor allowances to teachers and staff,” added sharma.

President of Guardian’s Association Nepal Suprabhat Bhandari said it’s not logical to increase fees and they would not let the hike be implemented at any cost.

“If we don’t increase the fees, we cannot run our schools, since teachers demand their salaries and allowances as per the government scale. Besides, the prices of commodities have doubled in comparison to last year,” said Gita Rana, president of National Private and Boarding Schools’ Organisation (N-PABSON).

Private and Boarding Schools’ Organisation (PABSON), however, has not taken any institutional decision to this effect, said Bijaya Sambahamphe, general secretary of PABSON.

proposed monthly fee structure for five valley schools

Pathshala Nepal

Primarly level Rs. 1,500
Lower Secondary Level Rs. 1,800
Higher Secondary Level Rs. 1,900

Xavier International

Primary Level Rs. 1,800
Lower Secondary Level Rs. 2,100
Higher Secondary Level Rs. 2,450

Galaxy Public School

Primary Level Rs. 2,600
Lower Secondary Level Rs. 2,800
Higher Secondary Level Rs. 3,000

VS Niketan

Primary Level Rs. 1,200
Lower Secondary Level Rs. 1,695
Higher Secondary level Rs. 1,995

Chelsea International

Primary Level Rs. 2,000
Lower Secondary Level Rs. 2,000
Higher Secondary Level Rs. 2,200

Private and boarding schools are set to hike school fees by 20 percent across the country from next academic year that starts from April 15.

The schools have sent a proposal to the Fee Determining and Monitoring Committee under the Ministry of Education (MoE) to this effect.

According to officials, the proposal has crossed the fees limitation determined by the committee.

If the proposed fee structure comes into effect, students studying in small and medium schools have to pay Rs. 50 to Rs. 300 and those in big schools will have to pay around Rs. 700. As many as 900 boarding schools of Kathmandu valley have already made their proposal to the committee.

According to Kathmandu District Education Officer Gyani Yadav, the committee held two meetings with the school authorities on Thursday and Saturday.

“The proposed fee structure this year is higher than that in the previous years,” said Yadav. “Since teachers’ salary and other facilities to them have not been increased, they might not hike the fees though,” he said.

However, he said that the fees issue would be solved before the new academic session begins.

But majority of schools in Lalitpur and Bhaktapur districts have not submitted their fee proposal yet. According to Bhaktapur District Education Officer Nira Shakya, the committee in Bhaktapur is holding a meeting this week to discuss school fees. There are 250 boarding schools in Bhaktapur.

Officials at MoE said boarding schools across the country have proposed 20 percent fee hike. Interestingly, schools in the valley have already started charging additional fees though the committee is yet to give a nod to the proposal.

Private and Boarding Schools Organisation in Nepal (PABSON) however has not taken any institutional decision to this effect, said PABSON President Rajesh Khadka. PABSON had increased Rs. 1200 in all grades last year.

There are nearly 8,000 private and boarding schools across the country and they should make the proposal regarding fees hike two months before the new session starts.