Poems

Friday, May 15, 2020

Ensuring access to sexual and reproductive health services amid lockdown





"One of the most profound impact of COVID-19 has been on the lives of women and girls. The lockdown and quarantine measures imposed to curb the spread of virus have put millions of women around the world out of reach of birth control options and other sexual and reproductive health (SRH) services"



The COVID-19 public health emergency has already become a crisis of global proportions as countries imposed national emergency, restrictions on travel, including stop-movement orders. This pandemic has placed unprecedented pressures on our health and social systems. Frontline service providers and systems, such as health, policing and social welfare, are overwhelmed by a plethora of activities related to preparedness and response of the COVID-19 pandemic. The major efforts of the entire health system and workforce are directed towards containing the spread of the disease and often the resources are diverted from the routine health services. In doing so, there is a risk that essential health services which communities expect from the health system, would be compromised. The health seeking of many essential services has been deferred because of lockdown and physical distancing requirements coupled by fear of COVID-19 exposure on venturing out of the house. Nepal has been under lockdown since March 24 and stays to continue till date. With no clear plan about going back to the normal life, the end to the lockdown is still not clear. This are public concerns whether this lockdown would be extended indefinitely.

One of the most profound impact of COVID-19 has been on the lives of women and girls. The lockdown and quarantine measures imposed to curb the spread of virus have put millions of women around the world out of reach of birth control options and other sexual and reproductive health (SRH) services. Confined to the home with their partners, they are much at risk to face unwanted or unplanned pregnancies. Because of COVID-19 related travel bans and closure of many clinics and health facilities, women are less able to access critical SRH services such as maternal health care, contraceptives and family planning, abortion, screening and treatment of STIs & other reproductive morbidities including other routine services. For women using long acting reversible contraceptives such as implants and intra-uterine devices, there might be a need for replacement, re-insertion or switching to another method due to side effects, complications or completion of duration. Even for those using short-term methods such as oral contraceptive pills and condoms, going out to procure a contraceptive is relatively difficult. In both cases, as the services are unavailable, more women are likely to experience unplanned pregnancies. Some women may opt for an abortion and many of these could turn out to be unsafe as the crisis could push women to take abortion drugs without supervision or seek help from people who lack training. Women also face greater exposure and vulnerability to gender-based violence and other harmful practices as they have been obliged to spend long hours at home with abusers, and with limited options for seeking help and support. This is especially problematic for women and girls from hard-to-reach areas including marginalized groups and those with disability. 

Even in places where health services are available, many women refrain from visiting health facilities as they fear being beaten by security forces and accused of defying the lockdown. Although government has long ago declared that the people seeking essential services would be allowed to commute freely, there is no public transportation available. On the other hand, due to shyness and fear of stigmatization women often might not be in a state to openly disclose the reasons to the security forces who impede their movement on the way to health centers. Nonetheless, many women prefer to seek family planning, abortion or other reproductive health services clandestinely from the health centers which are typically away from their residence. Meanwhile, outreach services, the key to reaching rural women and those furthest behind, have largely been suspended to avoid crowds and to prevent the risk of virus transmission from one community to another. The COVID-19 pandemic has also led to disruptions in supply chains across sectors, including with contraceptives and essential medical supplies. The impact of such disruptions are being manifested through stock-outs at health facility levels and community based distribution points followed by increased times for delivery of contraceptives.

Why should it matter?
A recent estimate from a Guttmacher institute revealed that even a 10% decline in contraceptive use in low and middle income countries due to reduced access would result in an additional 49 million women with an unmet need for modern contraceptives and an additional 15 million unintended pregnancies over the course of a year. The institute has also predicted that even a modest decline of 10% coverage of pregnancy related and newborn health care would have disastrous implication for the lives of women and their newborns. An additional 1.7 million women who give birth and 2.6 million newborns would experience major health complications but would not receive the care they need resulting in an additional 28,000 maternal deaths and 168,000 newborn deaths. Similarly, the estimates say that if 10% of safe abortions become unsafe because women cannot access safe abortion services amid lockdowns and clinic closures, there would be an increase of three million unsafe abortions and one thousand more maternal deaths in the low and middle income countries. On the other hand, the United Nations Population Fund estimates that 23 million women in 114 low and middle income countries may not be able to access modern contraceptives and 600,000 unintended pregnancies are expected to occur if the lockdown carries on for three months with medium disruptions to health services. In the same period, 31 million additional cases of gender-based violence can be expected to occur. It is therefore clear that the consequences could be severely catastrophic for women and their families if critical sexual and reproductive health services are reduced or suspended during the pandemic. The access to reproductive health services is almost always time sensitive and potentially life-saving and shouldn’t be deferred or placed on hold given any circumstances including a COVID-19 lockdown.

What can be done?
It is not logical to protect the people from COVID-19 and yet expose them to other fatalities against which government and other partners have made substantial investments over several years. So, the answer is clear and obvious; despite the lockdown and travel bans, it is imperative that the critical sexual and reproductive health services should be continued and made accessible to everyone without having to face barriers of any kind. However, the most indispensable question is How? The COVID-19 pandemic has been a severe stress-test for all of us. The existing health system is overstretched and preoccupied with preparedness and response activities such that its capacity to deliver the essential health services has been severely undermined. Despite these challenges, the health system should not depart itself from exploring innovative models and approaches of care. Given that the stringent lockdown and travel restriction measures are currently in place, asking women to visit health centers for the services they need might not be both practical and ethical, for many reasons. It is therefore imperative for a health system to adopt alternative models of outreach services in order to cater women at places near to their doorstep.

One approach is to revitalize and reposition the role of visiting service providers who are often found very effective in increasing the uptake of contraceptives especially the long acting methods by rural and marginalized women. Visiting service providers in the form of LARC ANMs, MS ladies or roving ANMs travel to rural health facilities and communities on regular intervals to cater the contraceptives and maternal health care needs of the women and girls. Although these cadre of service providers are currently available in more than fifty districts, mostly remote and hard-to-reach, activities of the majority have been suspended greatly ever since the lockdown. It is a stark reality that these cadres are barely utilized during this period of crisis although the entire health sector is struggling with health workforce shortages. Where feasible, health system must thus consider exploring the opportunity for mobilization of visiting providers by repositioning their role from a family planning service provider to the role as a provider of comprehensive sexual and reproductive health services. In addition, taking into account the local availability of human resources and current pressures on the health system, the local governments and health system authorities may also decide to mobilize other public health care providers (both nurses and paramedics) at peripheral levels to offer SRH and other critical health services in the outreach.

These visiting providers could plan a fixed service day for each village/ward area and organize comprehensive family planning, sexual and reproductive health outreach sessions. Such kind of sessions could be planned on dates and time decided locally based on demands from the community. The beneficiaries may be called in a small group of 3-4 per session to ensure adherence to physical distancing. The existing community networks such as female community health volunteers, local health workers and social mobilizers/volunteers might be utilized to identify and communicate about outreach services to women and girls with need for services, and this could possibly be done through the telephone or local contacts. Furthermore, in circumstance with special needs such as high-risk pregnant, post-partum mother, women with disability, and other women with special needs, the outreach services through home visits can be provisioned and optimized. Such home visits and outreach services should preferably be linked to temporarily established helpline/hotline services such that needs for additional support and referrals can be responded immediately.

Besides, offering family planning services to postpartum women through infant immunization contacts has been considered one of promising high-impact practices in family planning. Given the need for a health system to work efficiently by minimizing the frequency of people contacts, the opportunities could be explored to cater both, the infant for immunization and the mother for family planning and/or SRH services during their solo visit on immunization session.

Ensuring the uninterrupted supply of contraceptives and birth control pills and other essential commodities is another critical aspect to safeguard people’s access to sexual and reproductive health services. In rural communities, where reaching health facilities or private pharmacies could be a problem due to travel restrictions, different alternatives could be considered for increasing people’s access to contraceptives. One approach is to explore whether it would be feasible to make the short-term contraceptives such as condom and pills available at local grocery stores. Amid lockdown, the grocery shops remain open each day, even if it is for certain hours in a day and are often accessible to everyone. Local governments may appoint a local youth volunteer as runner to fetch contraceptive supplies from district/municipal store or health facilities up to these distribution points. Movements of such volunteers should be facilitated locally in coordination with local authorities and police administration.

It is also critically important to make the best use of existing digital and tele-health platforms to ensure the provision of reproductive health information, counseling and services. Digital platforms worldwide have become a more popular, safer and effective means to reach client with comprehensive and reliable information and services during this lockdown period. A number of toll free helpline facilities are currently available for sexual and reproductive health services in Nepal. For instance, a Meri Saathi free helpline has been offering information, counseling and referrals on sexual and reproductive health issues through the dedicated counselors. Also, there are other hotline services and mobile health platforms operated by few other NGOs including the Ministry of Health and Population. In addition, a 24-hour hotline service operated by National Women Commission offers support to survivors of Gender Based Violence. Such hotline service can respond promptly during emergencies and offer referral services for women to receive health services, legal aid, psychosocial support, child support and safe shelter. Clients requiring any type of information and support services should therefore be encouraged to utilize these tele-platforms to obtain comprehensive information, identify a need to visit a health facility/hospital and to determine whether referral services are needed. A number of mass-media could be used to inform the public about its availability, to build public trust that these services are confidential and reliable and to promote the use of such services. 

Having considered all these approaches, the government and health system must also be thoughtful on few other basic issues. Firstly, as the public transports have been closed, health care providers may face difficulties in their commute to outreach sessions, particularly those who rely on public transports for their movements. Where feasible, the inter-mediate means of transportation such as bicycle, scooter or other local means could be provisionally made available to theses providers to enable their movements to distant or hard-to-reach areas. Secondly, the protection of visiting service providers is crucially important. Thus, before deployment for outreach services it is imperative that these nurses and health care providers are well-informed and orientated on the standard protocols for infection prevention and control and are aware of the advisories for infection prevention, personal protection and physical distancing norms. Provision for the adequate and appropriate personal protective equipment would be equally necessary. Lastly, the key to successful pandemic response and continuity of essential health services largely depend on how robustly the governments and health system apply their efforts and resources and how effectively the coordination has been sustained with other private and non-government sectors at local level.


For universal access to sexual and reproductive health services to become a reality, there is an urgent need for concerted efforts, quick and decisive action. It is the responsibility of everyone including the public health sector, governments at all three tiers, for-profit as well as not-for-profit sectors to devise necessary measures to ensure that reproductive health services remain readily accessible to everyone and ensure the functioning of community systems to protect the rights and dignity of all women and girls. While COVID-19 pandemic is inevitable, the devastating impacts of lockdown on SRH services can be significantly mitigated if the community level efforts are well-integrated.


This article was published at Online Khabar on 06 May 2020: Please follow the link below
https://english.onlinekhabar.com/ensuring-access-to-sexual-and-reproductive-health-services-amid-lockdown.html

Monday, April 30, 2018

पैसा

महादेवको तिनै नेत्र खुलाउने नि यही पैसा
आफन्ती र साथिभाइ लाई भुलाउने नि यही पैसा
हुने लाई त पुगिसरी मोज्मस्ती र ऐश आराम
नहुनेलाई धुरुधुरु रुलाउने नि यही पैसा
युवा जति खाडी विदेश डुलाउने नि यही पैसा
ऋणै ऋणको भूमरीमा झुलाउने नि यही पैसा
हुने जती समाजसेवी नहुने चै अभागी रे
त्यै अभागीको खोटो भाज्ञ खुलाउने नि यही पैसा
दस जन्मको पाप कर्म धुलाउने नि यही पैसा
गलतलाई सही भनी तुल्याउने नि यही पैसा
गर्नेको त हुँदो रैछ रोपाँइ अनि खेती यसकै
भ्रस्टाचार को बाटो टेकी कुम्ल्याउने नि यही पैसा
जुवा तास क्यासिनोमा लुटाउने नि यही पैसा
नाता गोता सम्बन्धलाई फुटाउने नि यही पैसा
महिमा नि अपरम्पार.. यो खोस्टे कागजको
हुँदै नभाको माया जुटाउने नि यही पैसा

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फेसबुक

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फेसबुक.....

के हो आखिर बिशेषता चै खास फेसबुकको
घण्टौं बस्न रेडी सबै पास फेसबुकको
साथिभाइका अपडेट होस् या ताजा समाचार
किन लाग्ने यती धेरै आश फेसबुकको
के हो आखिर बिशेषता चै खास फेसबुकको
किन बन्न रेडी सबै दास फेसबुकको
यसमै पूर्ण लिप्त अनी एकोहोरो पार्ने
साह्रै सशक्त रैछ ब्रेनवास फेसबुकको

ति फोटाहरू

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क्यामेराका रील गन्दै खिचाएका फोटोहरु 
बाल्यकालका याद सबै मिसाएका फोटोहरु
क्यामेरा नै हल्लाएर बाङो टिङो तिरमिर पार्दा
गलत खिचिस साथी भन्दै रिसाएका फोटोहरु
ठाऊँ ठाऊँका सिन खिच्न डुलाएका फोटोहरु
हिकोलाको कलर ल्याब मा धुलाएका फोटोहरु
नेगेटिभ नै जलेर हात लाग्यो सून्य हुँदा
ठुस्स परि नाक मुख फुलाएका फोटोहरु
मझेरिमा टिलटिल आँखा टल्काएका फोटोहरु
झिल्के बनि ढाका टोपी ढल्काएका फोटोहरु
कहिले काही कट्टी हुँदा साथिभाइहरू सँग
रिसको झोकमा च्यात्चुत पारि सल्काएक फोटोहरु
पिक्निकको रमाइलोमा कराएका फोटोहरु
साथीभाइले अटोग्राफमा भराएका फोटोहरु
कस्तो हुन्थ्यो होला आज एक एक गरी हेर्न पाए
समयको क्रम सँगै हराएका फोटोहरु.......

Monday, September 26, 2016

ADDRESSING UNMET NEED IN NEPAL

Nepal is committed to improving the health status of its people through improvements in maternal, neonatal and child health. In Nepal, various health plans, policies and strategies have all emphasized the need of equitable access to women for all reproductive health services.

In the area of Family Planning (FP), the Government of Nepal aims to enable women and couples to attain the desired family size and have healthy spacing of childbirths by improving access to FP services and reducing unmet need for contraceptives. Unmet need refers to the percentage of women who do not want any more births or those who want to postpone the next birth but are not yet using any method of contraception. Although there have been large investments and extensive efforts by both public and private sectors in family planning, there has been no remarkable progress in the use of modern contraceptives and in reducing unmet need in the last few years.

Current situation of Family Planning and Unmet Need
The Nepal Demographic Health Survey (NDHS), 2011 suggests that the contraceptive prevalence rate (CPR) of Nepal is 49.7%. Survey results from past fifteen years show a notable increase in the use of modern contraceptives. However, NDHS report shows that a modern CPR that increased from 1996 to 2006 has stalled between 2006 (44.2%) and 2011 (43.2%). Although Multiple Indicator Cluster Survey (MICS) showed that the modern CPR has increased to 47% in 2014, FP services are not yet universal across the country with significant disparities across regions.

Further, a higher unmet need in Nepali women provides a scope for equitable expansion of FP services across the country. The unmet need for FP in Nepal was 25.2% in 2014(MICS) which is a steady decline from that of 2011 (27% as per NDHS). Various studies and survey data reflects that highest unmet needs are amongst the women in rural and hilly areas. Also unmet need is highest among women in the poorest wealth quintile. Greater demand for family planning is among 35-39 age group women. The unmet need is also significantly higher among mothers within 24 months postpartum.

National Programs and Policies on Family Planning
Family planning being one of the priority programs of Government of Nepal had been considered as a component of reproductive health package and essential health care services of Nepal Health Sector Program II. The New Health Policy (2014), the Second Long- Term Health Plan (1997–2017), and the National Reproductive Health Strategy (1998) have all emphasized on the need of equitable access to FP services.

Under current National Family Planning Program, short-acting FP methods such as male condoms, pills, and injectables are offered regularly through all peripheral government health facilities including PHC-ORCs and FHCVs (condom and resupply of pills). Long acting reversible contraceptives (LARCs) are limited to few Primary Health Care Centres and Health Posts. Sterilization services are either provided at static sites or through scheduled seasonal or mobile outreach services. District FP MNCH clinics also provide all types of temporary family planning methods on regular basis. Various I/NGOs and private sectors are also the major stakeholders in FP services and support national programs in various ways.

Major gaps and challenges
Both at the demand and supply side various gaps and challenges exists; which constraints FP access and uptake. At supply side major gaps lie in the shortage of trained FP service providers and lack/ stock outs of family planning commodities and supplies. While Ministry of Health aimed to provide at least five types of modern FP methods from Health posts by 2015, all five methods are offered by only 43% health facilities. According to the Facility Based Assessment of Reproductive Health Commodities and Services, 2014, although stock outs of condoms, pills and injectables were negligible, 20% of PHCCs and 28% of HP had stock out of IUCD and implants for various reasons. Further, lack of proper counseling on FP including during postpartum and post abortion visits may also be another reason for low uptake of modern contraceptives.

In the demand side, the family planning use are more constrained by several factors like time taken to reach health facility, lack of transport, costs of travel, myths, misconceptions and fear of side effects, family restrictions, etc.

Appropriate Strategies
Taking into considerations the current FP situation, existing programs, policies and the efforts to address prevailing challenges and gaps, following strategies are appropriate to reducing unmet needs.

1.    Increase demand generation.
  • Develop and implement FP sensitization program targeting hard-to-reach people: Focus marginalized groups and rural communities with high unmet needs.
  • Implement BCC interventions targeting specific groups with higher unmet needs: Conduct mapping to identify such communities.
  • Address fear of side effects, myths and misconceptions about FP through widespread use of IEC materials and other communication channels and prioritize interactive IPC sessions through FCHVs and health workers.


2.    Build Capacity of Service Providers
  • Conduct trainings including refreshers for enhancing quality service delivery, particularly on provision of LARCs and quality FP counseling. Prioritize providers in areas with higher unmet need.
  • Promote onsite coaching to improve and sustain providers' skills on FP service delivery especially LARCs.

          
3.    Improve Service Delivery
  • Expand LARC services (commodity, trained service provider, equipments and IP supplies) up to health post levels.
  • Integrate postpartum family planning (including PPIUCD) services in Health Facilities with birthing centre to address postpartum FP need.
  • Promote task-shifting to expand services especially in districts with high unmet need.


4.    Reposition Family Planning
  • Promote "Well-Planned Family" concept to establish positive image of family planning.
  • Make FP services adolescent friendly to address unmet need of adolescents and youth.
  • Redesign FP programs so as to increase male involvement.
  • Promote special FP campaigns integrated with social support programs to reach underprivileged groups.


5.     Improve logistics management
  • Strengthen logistics management system to reduce stock outs and overstocks of FP commodities and supplies at health facilities.
  • Strengthen supply chain management to support contraceptive security


6.    Encourage alternative strategies
  • Deploy roving ANMs to share family planning methods with hard to reach and underserved groups.
  • Expand social marketing of contraceptives to underserved areas.


7.    Integrate FP into other national programs
  • Integrate FP with services like immunization, emergency obstetric care and abortion.


8.    Promote Public Private Partnership

  • Engage private & NGO providers in FP and coordinate reporting on FP services by private sectors.   

From: Various Sources

Thursday, May 30, 2013

FACING THE CLIMATE CHANGE: One step at a time

Climate change is not a distant threat looming on the horizon. It is already here and has impacted all walks of life on earth. In Nepal, the impacts are more serious as it has hit the major livelihoods base of common people. Recent events have emphatically demonstrated our growing vulnerability to climate change. Although the consequences of climate change will be borne by all, particularly future generations can expect to bear a heavy burden because they will live longer and will face this challenge throughout their lifetimes. The situation of youth in developing countries like Nepal is especially fragile. In Nepal youth (16-40 years) make up 38.8 percent of the total population and many of them are already facing a difficult transition to adulthood owing to social and economic instability and widespread poverty.
                                                                                  
Addressing and adjusting to the challenge of climate change is certain to be a defining feature of the future of today’s youth. Till the date an overwhelming majority of youth point out political leaders to do all they can to stop climate change, but youths themselves have not taken their own responsibilities in this context. It is therefore critical that young people educate themselves and become more conscious and responsible by getting actively involved in combating this threat. Youth can make a difference provided they realize their importance to their society, nation and the earth as a whole. Youth have long been involved in environmental protection activities at the school and community levels, but the time has also come for them to participate more actively in shaping global decisions relating to climate change. Young people must contribute to the process of addressing this critical challenge, as they will feel its impact most acutely throughout their lives.

Youth and youth organizations have an important role to play. Throughout the world, youth have developed creative ways to raise awareness, share information, build capacities, and work together on climate change mitigation and adaptation practices often achieving impressive results through their own initiatives. It is high time for youths to continue this legacy by further nurturing their novel ideas and acting prudently to save the planet Earth. We must also be the real players to substantiate the idea of ‘green economy’ in sustainable development.


The main constraints youths of today face in taking action include hesitations about how and where to begin, limited confidence in their ability to make a difference, poor financial resources and a lack of political and community support. Even though these seem genuine concerns they should not be perceived as insurmountable obstacles. The fact is that youths can realize their aspirations for the superior earth even by introducing small changes in their daily lives, strengthening their commitment to action one step at a time. Although everyday measures to reduce carbon emissions and protect the environment may seem of no consequence, they can actually add up and make a real difference; especially when entire youth communities take a part. 

YOUTHS AND VOLUNTEERISM

Young people represent at least 18 per cent of the world’s population. In Nepal, youth (15-40 years) constitute about 40 per cent of the population. These cohorts represent a critical constituency for shaping of nation's future and are the pioneers of socio-cultural, political and economic reform. They are the crucial segments of nation’s development. While the lifestyles and attitudes of young people today are out looked with negative stereotypes, many youths in the country are actually the productive members of the society. The majority of youths in this country also engage in some form of volunteer activity, and many see the value of serving others. Youth volunteerism is becoming one of the keys to address development challenges.


Through greater involvement, youth volunteering facilitates access to work and contributes to forming young leaders for today and tomorrow. Volunteerism serves a valuable role in reaching special populations, such as orphans, children, people with disabilities, and other vulnerable communities and groups.


When youth get involved in volunteerism, benefits are reaped by almost everyone concerned- the target groups (children, poor, disabled, etc.), the community and most especially the involving youth themselves. Volunteerism has important implications for positive youth development. It encourages a sense of service and responsibility towards others, provides an avenue for developing skills and relationships, and facilitates the development of various social and leadership skills such as teamwork, communication, problem solving, project planning, time and task management, and organization.

Youth volunteerism has several benefits. Through volunteerism, youths can make services available to more people in the community, often helping the neediest population and/or areas that require special attention (schools, orphanage, old-age homes, etc.). In doing so, youths gain opportunities to learn new set of skills and provides valuable work experience. As youths intermingle with various organizations and people during volunteerism, it strengthens bonds to the community and broadens their support network, exposing them to people with common interests. Volunteerism provides many of the developmental assets of youth. The experience of volunteerism can help develop many social competencies. It helps in the realizations of one’s own leadership potentials, confidence, self-esteem and above all his/her own ability to make a difference.


UN Secretary, Ban Ki Moon stated, “Youth are a transformative force; they are creative, resourceful and enthusiastic agents of change, be it in public squares or cyberspace.  From their pivotal role in efforts to achieve freedom, democracy and equality, youth have energetically demonstrated yet again their capacity and desire to turn the tide of history and tackle global challenges.”



Photo Courtesy: Rotaract Club of Kathmandu Mid-Town