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VOL. 27, NO. 18, January 11, 2007 (Paush 27 2064 B.S.)
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"Government's Role Is To Guarantee The Service And Community's Role Is To Bring Family Up To The Service Center"
Ram Kumar Shrestha
RAM KUMAR SHRESTHA is a well known public health experts of Nepal. Recognized by global health summit as Vitamin A Sherpa, Shrestha has traveled around the world as a community health expert. Executive director of Nepal Technical Assistance Group (NTAG), Shrestha's major contribution is the mobilization of community volunteer health workers to provide Vitamin A capsules to millions of Nepali children. Despite suffering from political instability and bloody insurgency in the last twelve years, distribution of Vitamin capsules was never disturbed. Shrestha spoke to KESHAB POUDEL on various issues of community health. Excerpts:
As an internationally renowned public health expert working in various parts of the world, what has inspired you to be in Nepal?
This is my own country which gave me enormous opportunity to be an expert. I feel very proud to say that a program of such a small country could make such an impact in the world health sector.
At a time when many Nepalese experts like you are giving out pessimistic views about Nepal, why are you so positive?
Every country has its own problems. What we need to do is to serve the country and people living in remote parts of the country? I am optimistic because we Nepalese have the capability to make everything possible. Nepal's community health program and Female Community Health Volunteer has already won world recognition. This is a pride for all of us.
Don't you feel frustration and pessimism looking at country's unstable and chaotic situation?
A person's ability and capability can be tested in such a crucial time. Everybody will come when things are alright. When you work for the community deprived of all facilities saving the lives of people, you feel optimism.
How much disturbance have you felt in your programs?
Frankly speaking, Nepal's political instability and disturbance have not created any trouble to our program. For instance, Vitamin A distribution program is going on smoothly and all political forces and groups have been supporting us.
What is the reason behind it?
In our program, communities are involved. We distributed Vitamin A capsules to all children living throughout the country. Every family, whether rich or poor, knows that by administering a simple capsule, you can save your children.
How responsive are Nepalese communities?
I have already worked in a dozen of countries including in India but Nepalese community have some basic qualities, which others do not have. Nepalese communities whether in Terai, Pahad or Himal, there are more harmony than conflict as people respect religious sentiments and existence of others.
Don't you see the growing violence in southern terai and other parts of Nepal as an end to such harmony?
One cannot deny the fact that there are incidences of violence but forces of harmony are still powerful in Nepalese community. Recently, I also witnessed violence in terai when I was on the way to Biratnagar from Rajbiraj; some miscreants killed a government official. There are some problems in southern terai. So far as the relations in the community are concerned, there is still harmony at large scale.
If political situation continues to be unstable, how do you see the future of the programs like Vitamin A distribution and immunization?
I am certain that the programs will continue. Politics in the center has nothing to do it. As these programs are managed by communities for their broader benefits, they will do it. The ownership of these programs is with the community and family. Had these programs had any link with the government, these programs might not have produced successful results.
After successfully implementing a program to mobilize community through the Female Community Health Volunteers to provide Vitamin A, on what new programs are you working now?
Nepal has shown the world that it has capacity to bring out model programs. I am considering carrying out another program to make family responsive in health services. As the government has already established various types of health units up to the ward level and provides minimum medicines, the role of non-governmental organization is now to take families up to the service center. Now the government's role is to guarantee the service and community's role is to bring family up to the service center.
What is the basis of your concept?
Government needs to provide technical staffs, medicines and other logistics. As the government cannot go to each and every house to see the families, social and community organizations need to generate awareness in communities regarding the services. If we develop these kinds of relationship, we can address the issues of underserved population. Community and family needs to be responsible to acquire the service and government needs to be responsible to provide the service.
What is the state of the programs now?
Vitamin A capsule distribution program is going very smoothly. In early days, there was a need for motivation. Now they have developed ownership. Community has already taken ownership and FCHVs have been doing effective work.
What is the status of MDGs regarding child health?
Nepal still lags far behind in many sectors of MDGs. Communities involvement can make a lot of difference. For instance, Nepal is very close to achieve the MDG goal in children mortality. This is going to be possible because of successful programs of Vitamin A capsules distribution and other immunization programs. It seems that Nepal is going to be a country, which will achieve this target by 2015.If we provide support to FCHVs; we will be able to achieve other goals also.
How is it going to be possible?
When we started the program, infant mortality was per 171 per 1000. However, the recently published DHS report reveals that the child mortality is 61 per 1000. This was possible not only because of the vitamin A but there are also many contributing factors. The role played by FCHVs is highly important. There are 49000 volunteers now.
How do donor agencies see your programs?
Every country has been talking about this. Many countries of the world are in no position to achieve the MDGs. All the countries have government machineries but they don't have community level machinery. They are unable to reach in coverage. Nepal has the model and way for the mobilization of community. If we provide Vitamin A capsules twice a year and retain coverage of 96 percent, we can save 15000-20000 children.
