Reproductive Health
An Emerging Priority

By Jhabindra Bhandari

IN a country like ours where majority of the population live in rural areas and have poor access to primary health care, public health is remarkably an important agenda in the national development strategy. Increasing poverty, rapid population growth, degrading environment and poor status of public health are the key concerns of sustainable human development.

Many attempts have been made to improve the public health. The International Conference on Population and Development (ICPD) held in Cairo in 1994 was a major landmark. The ICPD conference has recognised Reproductive Health (RH) as a crucial part of overall health. And, this is furthermore central to human development.

Like many other priorities of health and development, Nepal as a signatory to the Plan of Action of the ICPD has shown deep concern to improve reproductive health status of the entire population throughout the country. Largely, multi-sectoral approach is utilised to achieve the purpose of RH.

RH is generally defined as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. The holistic approach of RH demands empowerment of people and active community participation to have RH services in a way that these are accessible, affordable and acceptable.

It is important of note here that the national RH strategy is in line with the context of the 1991 health policy is well as the 1997-2017 second long term health plan. The formulated policies and plans support national objectives of reducing infant, child, and maternal morbidity and mortality.

The RH programmes are therefore largely focusing on community participation and increasing access through the existing health facilities like district hospitals, primary health care centres, health posts and sub health posts. And establishing an effective referral system at all levels is another concern.

Family planning is an integral part of RH. With an objective of controlling population growth and reducing high maternal mortality and morbidity, family planning is gaining wider popularity in most of the developing countries of the world. The key purpose of family planning is to assist individuals and couples space or limit the number of children and prevent unwanted pregnancies. However, within the context of RH, family planning programmes are vital to improve people’s overall reproductive health.

Interestingly, there is a vast unmet need for family planning. According to annual report of Department of Health Services - 1998/99, the total demand for family planning is 59.9 per cent. Of this, only 28.5 per cent is met. This clearly pinpoints that there are big challenges of reaching the unmet needs of family planning.

As a matter of fact, Nepal experiences one of the highest maternal mortality rate in the world. Recognising the gravity of the problem, the safe motherhood programme was initiated in 1994 in
some selected ten districts of the country. The programme primarily aims at reducing maternal and neonatal mortality and morbidity. This is only possible if the programme adopts multi-sectoral approach in planning and implementation of a wide range of RH services at all levels.

The success of safe motherhood programmes is achieved only when there exists two-pronged approach in its operational strategy. There should be significant improvement and expansion of basic maternity care services, including family planning, for all women. And on the other side, social mobilisation is extremely important to increase access to these services. These are largely related to maternity care for women during pregnancy and encouraging timely referral as and when necessary.

It is true that there are many problems and challenge ahead to provide RH services for all. The low coverage of antenatal care, postnatal care and delivery services present a gloomy picture. In this regard, effective mobilisation of community health workers and volunteers is crucial. In addition to this, awareness raising programmes on a wide range of RH needs and services are equally important.

Recognising this reality, the Female Community Health Volunteer (FCHV) programme is operational to motivate and educate to mothers and community people for the promotion of safe motherhood, family planning, immunisation, and other primary health care issues. The major role of FCHVs is thus to promote community participation for creating awareness of utilisation of local health services.

In recent years, the adolescent RH has been a matter of priority. As the problem of Sexually Transmitted Diseases (STDs) including HIV/AIDs is increasingly a major threat in public health, this will yield serious negative consequences on socio-economic development. More importantly, STDs also increase the risk of HIV transmission. Therefore, information, education and counselling for responsible sexual behaviour and prevention of STDs including HIV should become integral components of RH services.

Since RH behaviour of people is heavily influenced by socio-cultural factors, community based interventions should focus on behaviour change communication activities. Empowering people by providing access to information and education is an important strategy to improve the RH status.

Gender discrimination is rampant in all aspects of social life in most societies of the developing countries. Eliminating social, cultural, political and economic discrimination against women is another challenge of promoting sustained economic growth. Undoubtedly, this particularly has effects on women’s RH needs and services.

This is encouraging to note that national and international NGOs are active to provide a wide range of RH programmes in the communities. However, the needs are still on the rise to reach such programmes in the remote parts of the country where people have limited access to health care. The indigenous health seeking behaviour is of fundamental significance as it largely affects the overall RH status of people.

In our context, the scope of RH is definitely an emerging priority. The new paradigm of RH focuses on human rights and human development as a central strategy. To accomplish the ambitious goal of RH, inter-sectoral co-ordination and collaboration among government agencies, NGOs and private sectors is essential. More importantly, it is necessary to strengthen and expand RH services at all levels to cover the entire population.

Can’t Say Yes To Bandhs

By Mohan K.C.

ANOTHER round of bandhs or total closure of normal activities nationwide has recently been announced by the six leftist parties. The Nepal bandh is definitely not in the line of things that are essential for the country that has been reeling under a state of uncertainty in many spheres.

No Benefit

The last week of this month will be quite out of the way experience for the already knocked around average Nepalese. As per reports, the bandhs are three days long for a start with another extra one called by some other group. It certainly will bring to a halt all the normal business within the country which is to no one’s benefit.

Petty interests are the fore of any attempts to disturb the fabric of normalcy in the country. Though it is true that the state of affairs in the country is not what it should be but going to the extent of three-day nationwide strike to press one’s point forward is just a matter of retrogression for the country. At a time when there is every need for a joint effort to take the country on the right path, everyone is shouting hoarse over one’s own particular selfish interests.

Demanding the resignation of the Prime Minister over a deal is justified but it must come through the right channel. Demanding the same in the Parliament is also fine. In a democracy, voices cannot be muffled. If iron handed tactics are used to silence the dissenters then the rights of speech are suppressed.

Criticisms must be listened to and if they carry weight then remedial measures should be taken. But, healthy criticisms do more good than harm. There may be people who consider every criticism in the negative light and do not take the message it carries. It is their misfortune that this opportunity to rectify one’ mistakes is lost forever. The other side of the coin is that criticism for criticism’s sake is playing foul.

This is evident in some of the activities of the opposition. Demanding the resignation of the Prime Minister is fine. The right to express their dissatisfaction is intact. If it had not been the case we would not be enjoying the fruits of democracy as we are doing at present. But, what irks is going too far. The government too must be aware of the fact that it is not the ruling party alone that makes up a democracy—the opposition parties and the general people too are participants in the whole exercise.

Being vehement also does not work like being indifferent. This is what has made the opposition parties take the extreme step for calling a three-day Nepal bandh that will be additional burden on the already tottering national economy. Everyone knows that even a one day nationwide strike can paralyse all activities and takes a long time to get free from the hangover. But, three days! This will set into motion a number of negative impacts. Business will suffer. National productivity will go down. Tourist arrivals will drop. Academic activity will come to a halt. And so on. If these were confined for only the three particular days then there would be a little less discontentment. But, unfortunately, the impacts will be far reaching and will be felt even for months to come.

One thing that is plain is that show of power is what the callers of the three-day or one-day bandh want. They do not care for the consequences that the nation will have to bear. As long as bandhs they have called becomes "successful" there is no other achievement to look forth to. The people have become not only tired but irritated of the frequent bandhs and when another spate of bandhs is round the corner an average citizen seemingly can do very little but pull his own hair in a show of helplessness.

The political parties represent the people in general. So in this light their activities should focus on making the people’s life better and not lead them down the drain. But this seems to be case rather than an exception.

The new millennium may have raised new hopes of a better tomorrow. But the way the country is heading, all hopes have been belied. The political leaders and the parties they belong to do not seem to be serious when it comes to the interest of the nation. After all democracy did not come on its own. It was their efforts and sacrifices that democracy has been in the country for over a decade. Yet, wisdom and maturity cannot be seen anywhere. If only an iota of each was present, there would have been constructive ways of dealing with the problems of the country.

Popular Theme

So many leaders have harped on the very popular theme of "consensus" but it will not materialise if it is just an expression to be uttered in public meets or interviews. Seriousness can only come about when the leaders see a common cause when it comes in the context of national interest. Only when this comes about can transparency be a reality. And transparency means much in a developing country like Nepal.

Time Makes You Different

By Ambar Mainali

TIME is powerful and it rules over mankind. With the flow of time people see marked changes in the way they look at things. A one time powerful might turn out to be weak. Somebody with dazzling beauty becomes awfully ugly. A highly admired intellectual finds himself turning senile. And even those with impeccable sporting skills lose the power to perform. All these examples of degenerating attributes give us a clear message. People need not boast about their skills. Everything in this world is temporary and will fade away as time passes by.

The things, which remain are the sweet memories. Journalists at Gorkhapatra Corporation also got the message straight and clear recently. You might be wondering what made the high-spirited scribes admit the reality. It was no more than a friendly soccer match. Colleagues from the TRN and Gorkhapatra including this writer were making tall claims. Though nobody had seen each other playing football, it sounded as if everybody was the star of the stars. Some were even predicting the scores. No wonder, everybody was banking on their skills acquired during the school or even the college days. The story then was certainly different. Everybody was young and chubby. Rigorous exercise was the rule of the day.

At least in the case of this scribe we used to have daily games and sports. Even when one played throughout the day, it hardly used to make any difference to the body. Other colleagues must have certainly gone through the same phase. It was this very feeling, which led all of us to believe that playing a full match was not a big deal at all. What we failed to acknowledge was that things are different now. Most of us are not doing regular exercise, let alone playing a full match. The only exercise, which this scribe is attuned to is getting on the motorcycle when heading towards office and getting down coolly.

On the final day all of us were very hilarious. The welcome part was that most of us had kept our promises and had made it to the ANFA complex. In no time all of us realized that skill and stamina wear away with the flow of time. Apart from a few, most of us were puffing and panting even during short moves. It was not too late before we realized that football was not the cup of tea of a journalist who is always busy digging for news. Most of us were waiting for the ball to come to us. Most of us missed the golden opportunity to strike a goal. Every once in a while there was the flouting of rules knowingly or unknowingly. Above all the intriguing part was that the TRN journalists and the Gorkhapatra journalists were trying their best to bring victory to their team.

The match came to an end with three goals on each side. It was indeed a pleasant experience playing with people who work with you and are sailing in the same boat with you. The day’s exhaustion was forgotten within no time. But to the dismay of many the exhaustion struck back the next day. The faces of the colleagues were worth giving a look. Everybody was complaining of acute pain in the legs. This scribe had a tough time climbing the stairs and the ache lasted for three whole days. Besides the blended feeling of euphoria and exhaustion, the friendly match gave us all a lesson. The lesson was that one should always prepare and practice before doing anything. Recalling the hay days of the past will not make a difference to what you are to face today. The other message, which needs to be given due consideration is that games and sports are the key to building a healthy working atmosphere in any institution. Games and sports apart from allowing individual actors to know each other better also contribute towards keeping everybody fit and healthy.