Nepal Red Cross Society

Transcription

1 Nepal Red Cross Society Community Eye Care & Health Promotion Programme (CEHP) Annual Progress Report 2008 In collaboration with

2 Table of Contents Executive Summary... 1 Context... 3 Politics and Economy... 3 Project Activities ) Community Eye Care... 4 Cataract Surgical Camps... 5 Mobile eye camps (screening and primary care)... 5 Services of Community Eye Care Centers... 5 Establishment of Surgical centre... 6 Trachoma prevention and treatment... 7 School Eye Health Programme... 7 Pre School Screening Programme... 8 Low Vision Services... 8 Training and Orientation on Primary Eye Care... 8 Face washing promotion... 8 Self sufficiency of CECC... 9 Expansion of ear care services in the CECCs... 9 Quality improvement on eye care... 9 Main results of self evaluation (Eye Care) Problems, solutions and recommendations Cooperation with partners Outlook for ) Water Sanitation and Primary Health Care Group Strengthening PHC Sessions IEC/BCC promotion Safe motherhood Water Project Sanitation Self reliance of community groups Main results of self evaluation Problems, solutions and recommendations Cooperation with partners/stakeholders Outlook for ) HIV and AIDS Prevention School based HIV Peer Education Action plan from the schools and follow up Training carried out by DCs Promotion of Safer Sex Behavior Support to PLHIV Main results of self evaluation Problems, solutions and recommendations Cooperation with partners/stakeholders (i)

3 Outlook for ) Organizational Development (OD) Harmonize and develop a common framework Development of ICAP Plan Transversal Themes Human Resource Development Main results of self evaluation Problems, solutions and recommendations Outlook for Risk Assessment Finance Conclusion Annex 1: List of abbreviations Annex 2: Volunteers and staffs at CEHP (at the last quarter of the year 2008) Annex 3: Cumulative HIV and AIDS Situation of Nepal Annex 4: Type of training and workshops conducted by OD (ii)

4 Executive Summary The Mid West Region is the least developed region of Nepal as per national development indicators. The Mid West Region has three zones and fifteen districts with a population of about three million people. The Community Eye Care and Health Promotion Programme (CEHP) contributes to improving the health situation by meeting the needs of the people in the areas of community eye care, primary health care, water and sanitation and prevention of HIV and AIDS, contributing to poverty reduction and to the achievement of the Millennium Development Goals (MDG) of the United Nations. Through the CEHP programmatic input the organisational development of the Nepal Red Cross Societies District Chapters in the Mid West is strengthened. Under the core services of the CEHP, the Community eye care component primarily addresses reduction of poverty induced blindness through curative and preventive eye care service in collaboration with various partners. The guiding principle is the global WHO initiative Vision 2020: The Right to Sight. In 2008, total of over 80,000 people received eye care service directly. Curative eye care services were provided for over 23,000 patients in four Community Eye Care Centres (CECCs). All four CECCs are continuing a holistic service approach to eye care providing optical devices and medicines in one stop service delivery. The CECCs are maintaining high degree of self reliance, with cost recovery of running costs, which is over 75%. These 2 CECCs will now be fully managed by the DCs from year The CECCs in Dailekh and Jajarkot are also improving cost recovery to the significant level, though they have low number of patient turnover and need some years to sustain fully. 555 poor patients, who were identified for cataract surgery in the CECCs, were subsidised through the poor patient fund and brought to Nepalgunj for cataract surgery to restore their eye sight. 6 surgical eye camps in hard to reach areas treated 2689 patients and 722 cataract operations were carried out to restore sight of the people from the rural, hilly and mountainous districts. 716 persons were trained and sensitized on eye care problems and trachoma prevention. The programme also reached 119 schools through primary eye care training to the teachers and screened the vision of 25,571 students. Likewise, pre school screening of 2,556 children was carried out and 33 children were referred to primary eye care centers and the eye hospital for further case management. Under the Water Sanitation and Primary Health Care (PHC) component, CEHP is promoting a community management process to improve health and sanitation in the communities through 238 community groups who identify health problems in the community and plan, implement and monitor actions to improve their health situation. 12 core facilitators and 28 community facilitators in Jumla, Salyan, Pyuthan and Bardia carry out information sessions, facilitate the planning and capacity building of the community groups. More than sessions on primary health care including demonstration session were carried out by the community facilitators. In order to better focus on the different actions, each community group identified so called action members who are in charge for the implementation and monitoring of one single health action such as a person for safe motherhood, another for water and sanitation, other for HIV, etc. 1,190 action members are already in place. Since the formation of the action members, the impact of the health actions in the community groups is much higher and more obvious. Transport system for pregnant women to the health post has been established by 19 groups, and 73 groups have started a revolving fund for safer motherhood. More pregnant women reported to visit the health post for Antenatal care (ANC) than in (1)

5 the past year. However, a large number of women complained about the lack of medicines and equipment in the health posts and frequent absence of staff. Thus the project has started to develop useful links with relevant stakeholders to improve the provision of services at the health post level. Community group members have constructed latrines. Out of this, families have constructed a sanitary latrine, subsidized by Red Cross funds. Demands for sanitary toilets were much higher than expected. People are well sensitized towards the advantage of toilets. Two new gravity fed water systems (GFWS) were completed in Jumla and three more are still under construction in Jumla and Pyuthan. The survey of a fourth GFWS in Salyan has been completed and work will start beginning of Four spring protection water scheme in Pyuthan and Salyan are completed and further three systems are under construction in Salyan. The community groups have undertaken several other activities, e.g. cleaning of footpaths, road works, forestation, building stretchers for transport of people to health posts, improving household hygiene through waste pits and sun dry stands. HIV prevention and awareness programme in schools has been implemented in 180 schools in 8 districts. The programme components have been planned ensuring compatibility with Global Alliance on HIV and AIDS. In year 2008, a lot of focus was given to institutionalisation of the HIV prevention and awareness programme in schools. Support for the staff members has been stopped and the programme management role has been taken up by the volunteers or by the chapter's staff members, who have been trained in the past to manage HIV prevention and peer education at schools. Extensive orientation was carried out to the Red Cross District Chapters (DC) and sub chapter level volunteers to boost understanding of institutionalisation. Initially difficulty was faced but gradually it was taken up by the DCs. School management committees were also oriented to 196 times. The district chapters have carried out 6 Basic Training of Trainers courses for 115 school teachers, 149 schools developed plan for a year and implementing the activities as per plan. The schools have trained 2,312 core peer educators (PE) who disseminate information on prevention of HIV/AIDS to other peers and also to the community, where they reached 36,245 people. In order to transfer peer education skills among the other students of each program schools, the trained PEs with the help of trained teacher of their respective schools carried out 1,727 interaction sessions at the school level on 13 different topics focusing on "HIV and AIDS prevention and reproductive health" during 1 year period. Street dramas and competitions were organised marking National Condom Day and World Aids Day. Since this year, the programme focussed on identification of positive cases, de stigmatisation and linking positive people to existing services and self help groups. 166 persons were referred to Voluntary Counselling and Testing (VCT) centres for testing and 67 persons were financially supported to access CD4 count in Kathmandu or Nepalgunj. The programme also started the greater involvement of positive people in the capacity building and during international day and public events. Nepal Red Cross Society (NRCS) is a volunteer based organisation with district branches in every district and various sub branches. Under Organisational Development (OD), CEHP helps assessment of organisational capacity of the DCs through a tool called Institutional Capacity Analysis Process (ICAP). Based on the outcome of the 10 parameters through 116 indicators, each branch develops an action plan on how to tackle their weaknesses. Through the programme components and offering special workshops on conflict management, resource mobilisation, Red Cross movement principles dissemination the CEHP supports the chapters to enhance the project development and management skills of volunteers and staff. CEHP has carried out 3 new and 6 review ICAP assessments for 9 district chapters from the hilly district with the participation of 141 executive members from the chapters and subchapters. (2)

6 CEHP carried out a Training of Trainers (ToT) on ICAP for all DCs (only 12 districts could participate) from the Region. CEHP continued the quarterly publication of the "Chetana" bulletin, sharing success stories and lessons learnt from the communities and branches to various stakeholders and beneficiaries on project activities. Following the recommendations of the evaluation, the CEHP has worked out a monitoring and evaluation (M&E) framework with the help of an external consultant. This M&E framework has been implemented and followed right from the start of this phase and will be reviewed in the beginning of Monthly reporting from the field to the CEHP base and SRC headquarters follows strictly the M&E guidelines. In order to build the capacity in primary health care, a female expatriate health adviser has been employed for one year to strengthen the health team in the areas of community facilitation, networking and institutionalisation of HIV and AIDS. These results make obvious that CEHP could provide extensive reach to the people with various services and the programme has been instrumental to further enhance institutional capacity, promote humanitarian role and image of the Red Cross. The positive image in the Red Cross also made possible to reach almost every places even during difficult time. Now the changed situation has brought further opportunity to work for the needy and vulnerable using our professional expertise. Context Nepal's topographical beauty and possibly the cultural heritage and practices give a feeling of richness; though it is one of the least developed countries in the South Asia. Nepal Red Cross Society with the financial and technical cooperation of the Swiss Red Cross implements the Community Eye Care and Health Promotion Programme (CEHP) in the Mid West development region of Nepal, promoting improvement of the health status through the implementation of community eye care and health promotion services. This phase of project is commenced from April 2008 till December This new project phase was jointly planned with all partners in January 2008 and follows a newly developed log frame and indicators. The joint planning ensured that our resources and efforts are aligned towards the IFRC's Global Agenda to contribute MDG. Politics and Economy Nepal has become a Federal Democratic Republic after the Constitutional Assembly overwhelmingly voted for the abolition of the 240 year old monarchy on May 28, However, the political and security situation in the country remains fragile. General strikes and blockades are still very much common in cities even though the Mid West is less affected with such actions in comparison to the East Terai. This situation brings continuous negative effect on commerce and industry, with many industries being closed. The present fragile political situation and the transitional scenario also have an impact on the institutional management, which has made human resource management and volunteer mobilization a challenge. Planning for the present phase, which was ended in December 2007, of the project was shifted for January 2009 because of the plan for Constitutional Assembly (CA) election in November Later on the CA election was postponed to April This situation led to 'no cost extension' of the previous phase of the CEHP project for January March 2008 and new phase started only from 1 April Since the elections in April 2008, access to all districts has been eased. Village Development Committees 1 (VDCs) have been gradually reactivated and resumed their duties, though these institutions still lack elected people's representatives. 1 VDC = smallest administrative unit in Nepal (3)

7 Project Activities CEHP's core area of work are community Eye care, Water Sanitation and PHC, HIV Prevention and OD as a crosscutting to strengthen capacity of DCs of the mid west region. All the projects on the said areas are implemented by the district chapters of the region with the technical input of the project. CEHP carried out program orientation and discussion to the DC members of phase following its approval and agreement of SRC and NRCS. This led to the signing of an integrated collaboration agreement between DCs and CEHP to implement the following project activities. This report elaborates End of Project (EOP) results, its indicators, analysis of the results and details of the activities carried out in year 2008 during April December in each components. 1) Community Eye Care Photo: Eye patients operated at the cataract surgery camp. CEHP supports implementation of community eye care activities in 5 districts of Bheri zone and 2 districts of Karnali zone. The districts in Bheri zone are Banke, Bardia, Surkhet, Dailekh and Jajarkot; and the districts in Karnali zone are Dolpa and Humla. The community eye care activities primarily address reduction of poverty induced blindness through curative and preventive eye care in collaboration with various partners. The guiding principle is the global WHO initiative Vision 2020: The Right to Sight. Objective 1: To reduce the avoidable blindness through the provision of curative, promotive and preventive services Result 1.1: Cataract surgical rate increased in Bheri and Karnali zones Indicator: Cataract surgical rate (CSR) progressively increased by 10% per year. Result analysis: In order to reduce the backlog of cataract blindness and 'operable' cataract it is necessary to operate each year on at least as many eyes as develop cataract (incidence). The incidence of cataract is estimated 2,500 in the programme area of CEHP and have planned to achieve 1,984 surgery by the end of CEHP has altogether carried out 1,277 surgeries through below mentioned services. (4)

8 Cataract, a blinding eye disease mainly due to aging process is the major cause of blindness in Nepal. In order to reduce poverty induced blindness from the programme districts, CEHP carried out various activities like Cataract surgical camps in remote locations of the programme districts and mobile screening eye camps to identify and refer blind patients to the nearest eye hospital or to the surgical eye camps. The cataract patients were also identified and referred by the 4 CECCs operated by the DCs. The programme also built the capacity of the teachers and volunteers network in the programme districts to upgrading their skills to identify and refer eye patients to the appropriate locations. Please find details hereunder of the said services. Cataract Surgical Camps Because of poor access and economic barriers, also for many more years to come, the surgical eye camps will remain to be one of the most important service for the people in remote and rural areas to restore their eye sight. The cataract surgery camp provides eye care services to the residents of most remote areas. The eye camps carried out in a particular location provide services not only to the people of the district, but also serves people of several other neighbouring districts. 6 cataract surgery camps were conducted in hard to reach areas of Dailekh, Jajarkot, Dolpa and Surkhet districts of Bheri and Karnali zone (where patients from Humla, Mugu, Achham and Salyan districts also got services).; 2,689 patients were treated, 722 major surgeries and 51 minor surgeries were performed to restore their sight. An eye camp was also carried out in Humla in cooperation with the Himalaya eye hospital Pokhara, and CEHP had conducted screening camps and referred cases for cataract surgery. Additional 555 patients had cataract surgery at the CEHPs referral hospitals, the Fateh Bal Eye Hospital of Nepal Netra Jhoti Sangh in Nepalgunj and the Nepalgunj Medical College utilising the poor patent's subsidy. Mobile eye camps (screening and primary care) The primary eye care/screening camps basically aim at reaching the unserved and vulnerable communities with basic services on primary eye care. Along with services to the needy, this programme also establishes links with the grassroot organizations to promote education and dissemination of eye care services. The mobile eye camps are always organized by a community level Red Cross unit or other NGOs or Community Based Organisation (CBO)s. Many of the screening camps were also organised prior to a surgical eye camp in the hilly district. During this period, the primary eye care mobile camps were conducted in 113 locations. 12,005 patients were treated and health education was provided. 2,012 cataract cases were referred to the CEHPs referral hospital, the Fateh Bal Eye Hospital (FBEH),, for surgery. Glaucoma can also cause blindness if it remains untreated. In order to further sensitise people to seek early service to manage glaucoma, CEHP promotes awareness education among people and also refers glaucoma cases from eye camps and CECCs to the eye hospitals for speciality management. 97 cases are already referred for this service. Services of Community Eye Care Centers There are four fully operational CECCs located in four districts of Bheri Zone i.e. Bardia, Surkhet, Dailekh and Jajarkot; delivering eye care services at the clinic and community. All centres are actively involved in clinical, preventative and promotional eye care activities. (5)

9 During this year, the CECCs provided curative care and health education services to 19,270 new patients. Among them over 30% visited CECC within 7 days after their eye problem occurred. The CECCs also performed 39 minor surgeries and referred 2,558 cataract patients for surgery to the eye hospital and eye camps. All the CECCs are providing holistic services under one roof with optical fitting and pharmacy. The CECCs have also started ear care services since early I can do most of my work I am Mana Bishwakarma (57 F) from Pokharikanda VDC 3, Surkhet. My eyes were tested three years before at my VDC by an eye care team. They had advised me get operated at the eye camp in Bidhyapur, which was one and half days walk from my home. At that time my husband was not interested to bring me there. I also did not want to come because I feared the surgery and I could still see a bit. My eye sight slowly declined and I couldn't see at all with my right eye and could see only very little with my left eye. I feared that I will soon going to be blind. Then I kept asking my family members to take me for an eye operation. But Nepalgunj was very far from my village and the cost would have been very high, which was not affordable for us. This situation remained like this for two years. Luckily, this year Red Cross organised a screening camp at my village and they suggested me to come Bijaura village, which is 4 hours walk away, for eye operation free of charge. The Red Cross volunteer told me that food was also arranged for the operated persons. This time, my husband took me to the camp and my right eye was operated. There was almost no pain. Now I can see every thing as before, and can do most of my work. I realize that if my eyes were operated two year ago I would not have born so many difficulties. Thanks to Red Cross and doctors for helping me. Establishment of Surgical centre Birendranagar, the headquarter of Surkhet district is one of the main trade centres in the Mid west region. It has the potential to provide surgical services for the people of hilly districts. Considering this potential and the need to serve the vulnerable population of the hilly districts, collaboration possibilities to expand the Surkhet CECC into a surgical centre to reach the people from the hills around Surkhet district were explored. Discussion continue with the FBEH and potential donors to materialise this service. It is expected that this service will start in early NRCS Surkhet is also attempting to develop this CECC into a Community Eye Hospital. There had been consultation and meetings in the past with Tilganga Eye Centre and Fateh Bal Eye Hospital, even though without success. The DC with the help of NRCS HQs also put together a proposal to the Indian embassy to obtain funds. The Indian Embassy agreed and gave provisional interest letter to NRCS to establish the community eye hospital at Surkhet. The Government of Nepal (GoN) Nepal has already provided a good size of land (about 10,000 Square Meter) for the building. The chapter has requested CEHP to provide technical support to coordinate with relevant agencies and also for developing plans. DC Surkhet has assured their support to design technical aspects of the infrastructure (mainly buildings). Result 1.2: Prevalence of trachoma (active/blinding) in Surkhet, Dailekh, and Jajarkot districts are reduced and trachoma eliminated as per WHO definition in Banke and Bardia districts. Indicators: Trachoma prevalence reduced to 5 % among children below 10 years of age in Banke and Bardia by 2010 Reduction of blinding trachoma by 20% among adults above 30 years of age in Surkhet, Dailekh and Jajarkot by 2010 Result analysis: A prevalence study carried out in late 2008 reveals that the Trachoma prevalence is reduced to 1.1% in Banke and 3.3% in Bardia among children below 10 years of age in Banke and Bardia. This makes obvious that the Trachoma is no more a public health problem in Banke and Bardia, which was in the past the districts with the highest prevalence rate. The trachoma situation in Surkhet, Dailekh and Jajarkot will be studied in year (6)

10 Trachoma prevention and treatment Trachoma was one of main cause of blindness in Nepal. The Bheri zone in the Mid West development region was the highest trachoma prevalent zone (heperendemic zone 31.1%) in Nepal. Through the continued intervention by the Community Trachoma Control Programme since 1989 implemented by NRCS with the technical and financial help of Swiss Red Cross in the most prevalent districts Banke and Bardia, the situation has improved immensely. In collaboration with the National Trachoma Programme, the CEHP carried out a trachoma prevalence survey in Banke and Bardia districts in December Analysis shows a significant reduction of active and blinding trachoma. According to the survey Banke district finds Trachoma Follicles of 3.3% and Bardia 1.1%. where as it was 9.7% and 7% in Banke and Bardia respectively in year In the recent survey Trachoma Trichiasis (TT) prevalence in Banke was found to be 0.35% and in Bardia 0.45, where as it was 0.7% and 0.8% in Banke and Bardia respectively in year The survey was carried out as per the WHO guideline in the guidance of National Trachoma Programme. Bardia and Banke have now less than 5% prevalence of active trachoma. However, the prevalence in Surkhet, Dailekh and Jajarkot is still observed as high and needs intervention. The actual status will be assessed by the end of the year CEHP and CECCs integrate trachoma prevention related health education and awareness promotion activities along with TT surgery services in the eye camps. During this period, 110 TT surgeries were carried out and 68,646 persons were educated on trachoma prevention. Most of the CEHP and CECC staff members are trained on WHO recommended TT surgery technique. CEHP also carried out extensive Trachoma reduction activities in Surkhet, Dailekh and Jajarkot districts. 66 Eye Care Volunteers were trained and mobilized to carry out Trichiasis searching, referral of the patients to eye camp and CECCs and were also mobilized to carry out health education activities in the schools and communities. The volunteers reached 38,547 students and community members. During their services the Eye Care Volunteers distributed 105,524 Information, Education and Communication (IEC) materials. Most of the IEC materials were supplied by the National Trachoma Programme. Result 1.3: Identification and management of blinding eye diseases (childhood blindness, glaucoma, refractive error, low vision) is improved. Indicators: % of children served in 2008 increased annually by 15% % of glaucoma identified and referred to secondary eye care provider in 2008 increased annually by 15% % of clients identified and received correction of refraction in 2008 increased annually by 15 % Result analysis: The OPD clients' count for above mentioned indicators in year 2008 will be taken as baseline data for next years. Thus, this indicates till this period 2,556 children were served; 97 glaucoma cases were referred. The refraction service at the community outreach is yet to start. School Eye Health Programme The teachers are key actors in the society working with younger children and youth. Training them on primary eye care helps identifying eye health disorders related to students and children. This service also provides skills and information to the teachers and students on how they can support students and community members to keep their eyes healthy. Primary eye care and vision assessment skills are imparted to the teachers through training. The teachers usually screen the vision of the students twice a year at the beginning and in the middle of the academic year. The teachers receive necessary IEC materials and Vision Assessment charts to carry out the activities in the schools. The District Education Offices support the CEHP to carry out this activity. During this period, 119 teachers were trained and the vision of 27,571 students was screened689 students were identified with refractive error (abnormal vision) and other eye anomalies which were referred to the CECCs and Fateh Bal Eye Hospital. (7)

11 Pre School Screening Programme Prevention of childhood blindness is one of the major components in the Vision 2020: The Right to Sight campaign against blindness. CEHP implements pre school screening activities to address this need. Primarily this programme makes community people aware that they need to act on prevention of blindness in the early age of children by seeking services from the proximal health centres as soon as possible to make vision rehabilitation possible. The activity is carried out in the communities targeting all children aged between 1 9 years old. A technical team of CEHP examines thoroughly their eyes, provides possible treatment and gives education and advice on the spot. Those who can not be served there are referred to the nearest CECC or to the eye hospital. This year in three areas of Banke district pre school screening was conducted and 2,556 children were examined. 33 children were found with refractive error, squint, etc. and were referred to the eye hospitals for further management. Low Vision Services One important component of the Vision 2020 initiative is for the service on refractive error and low vision. This service is mainly focused on children of young age, even though other age category also need this service. CECCs and CEHP provided low vision services for 41 patients. Out of them 3 patients vision was improved with optical devices. The remaining patients were referred to FBEH for further management. Information related to low vision was incorporated in the primary eye care training carried out in the programme area. Training and Orientation on Primary Eye Care CEHP integrates eye care service with the existing health care services of the Nepal Government. In order to improve access and to promote primary eye care, education and referral of the patients to the eye hospital and centres, the CEHP carried out primary eye care orientation training to Government of Nepal s Mother and Child Workers, Village Health Workers and Female Community Health Volunteers. Under this service, 372 health workers were trained. 2 orientation sessions were conducted for 38 medicine sellers in Banke and Bardia and 4 orientation sessions addressed 121 traditional healers in Humla and Dolpa districts. Nepal Netra Jyoti Sangh through the Fateh Bal Eye Hospital provided 23 and 22 primary eye care kit boxes to the CEHP for the Health Post In charges during the Primary Eye Care refresher training in Dolpa and Humla. The kit contains a Visor, Primary eye care booklet, Epilation forceps, Torch light, Blue torch, Fleuroceine strips, Vision chart and a set of eye posters and brochures. Result 1.4: Measures to prevention of blinding eye diseases are practised by the community people Indicator: 2/3 of children in Jajarkot, Dailekh and Surkhet wash their face at least 2 times per day by % of persons with eye problems visit a health care facility within 1 week for treatment Result analysis: Face washing ratio will be assed through KAP by the end of Extensive activities are carried out during this year. Attending health care facilities by the patients are also be assed through KAP but the assessment carried out with the patients visiting the CECCs indicates that over 30% clients visited CECC within 7 days of onset of eye problems. Face washing promotion Face washing is the most important approach to prevent transmission of trachoma and other communicable eye diseases. Dissemination of this approach through Junior Red Cross Circle (JRCS) volunteers up to the community can have significant impact on the issue. Thus CEHP carried out extensive orientation on face washing to the JRCS and teaches especially in Surkhet, Dailekh and Jajarkot where the prevalence of trachoma is high. Such orientation was also carried out in Dolpa district for 609 students, which also included information on primary eye care. 119 JRCs Teacher sponsors/teachers were oriented on importance of face washing in order to initiate this activity at their school. 84 JRCs/schools carried out face washing activity at their school. 18,976 Students were reached with face washing education/messages. (8)

12 CEHP also provided IEC materials and radio messages to disseminate preventive measures on trachoma and other eye diseases. CEHP has distributed 111,131 copies of IEC materials related to trachoma. During various activities 7,119 brochures and 6,038 posters were also distributed to various members of the community. Result 1.5: CECCs achieve full self reliance and/or move towards self reliance; Surkhet and Bardia contribute towards the outreach service. Indicators Bardia and Surkhet CECC achieve 75% financial self reliance by December 2008 Jajarkot CECC recovers 30% of operational costs by 2008, 45% by 2009 and 60% by 2010 Dailekh CECC recovers 50% of the operational costs by 2008, 65% by 2009 and 75% by 2010 Bardia and Surkhet contribute 10% to the outreach programme cost in 2009 and 20% in 2010 Result analysis: 3 CECCs meet out the target for achieving the results as indicated. Bardia CECC had slightly less achievement because of interference in the CECC service led by conflict between staff and CECC management of benefit issues. Self sufficiency of CECC All CECCs have improved their performance moving towards self reliance. Their productivity and income from the services are continuously increasing. The major source of income is from the OPD services including spectacle and medicine sale. Bardia CECC recovered 70.80% of costs during this period, Surkhet 84.43%, Dailekh 60.31%, and Jajarkot 37.03%. The chapters are still weak in seeking support from the local and other agencies to sustain the services. Each of the CECCs has developed its business plan to achieve more cost recovery. Bardia and Surkhet DCs are still insisting that the support for the CECCs needs to be continued for some more years despite of their potential to achieve 100% financial self reliance through local provisions. Bardia DC even lowered the benefit of the staff members at the CECC to make it compatible with other departments of the DC. This has created a conflict among the DC and staff members and for some time the service was also interrupted. Bardia DC even discontinued their outreach services for some time. CEHP will give further input to review the business plan in year 2009 and ensure the adherence of the DCs to the hand over agreement signed in September Expansion of ear care services in the CECCs Community ear care has become a popular service in the districts of Bheri zone as hearing disease are very common and its care and prevention does not need much effort and investment. The CEHP is supporting the CECCs, especially Jajarkot and Dailekh to diversify their services by including primary ear care. This will obviously increase the volume of the patients in the CECCs and also boosts the income of the CECC. Four Ophthalmic Assistants from the CEHP project and Janakpur project have attended training on ear care. More staff from the CEHP and CECCs have shown their keen interest to receive this training. Result 1.5: Quality of service is improved. Indicators Clients are satisfied with the services Bio safety guidelines are followed 85% of cataract surgery have an outcome of VA of 6/18 Result analysis: Client satisfaction survey tools are developed and tested; bio safety guideline is maintained and the follow up of the cataract operated patients has become a routine service. Over 75% of the patients operated had vision 6/18. More needs to be done to have further improvement. Quality improvement on eye care In order to improve the eye care services of the CECCs and outreach, activities to improve quality and make services more client friendly are also introduced. A questionnaire to carry out a client s satisfaction survey has been developed and pre tested in Bardia and Surkhet CECC. This will be used as a regular tool in year 2009 and 2010, allowing the beneficiaries to provide their valuable input to improve the service management of the programme. (9)

13 All CECCs have installed a suggestion box to seek feedback from the clients to improve the services of the CECCs. In order to ensure further community participation in the improvement of eye camp management, a suggestion recording system has been introduced placing a suggestion register during surgical eye camps. Important remarks made were e.g. to give priority for quick registration to patients referred from the screening camps, to increase number of volunteers and their services and to improve the sanitation level of the camp site. The project responded by increasing the number of volunteers in the eye camps and installing more temporary toilets during camps. The bio safety guidelines, developed and introduced by SRC in all of their eye care programmes, are strictly followed in the eye camps. They have also been introduced in the CECCs and for all events when surgery is carried out in the field setting. Additional equipments and instruments were bought to ensure bio safety standards and to improve the diagnostic quality of the CECC and outreach services. Staff members were also trained to improve their skills to use new equipments (biometry, refraction, etc.). CEHP has put further effort to improve quality of visual outcome introducing provision of A scan biometry and has also increased monitoring frequency of visual outcome of the patients operated at the surgical eye camps as per WHO criteria. Over 75% eyes had very good sight (6/18 and better) vision after surgery. However, most patients only visit for a second follow up. During the third follow up only a few patients appear, mostly the ones with poor eye sight. Main results of self evaluation (Eye Care) The CEHP team (including steering committee) reviews the programme on a quarterly basis. The main results of these self evaluations were following: CEHP continues to be successful to reach out extensively to the communities with various eye care services to address the reduction of poverty induced avoidable blindness. CEHP covered almost all health posts and schools in the programme districts. Almost all health posts and schools have trained eye care person. CEHP was successful to promote self reliance to all CECCs, despite of hesitation of DCs to cope with self management. The Bardia and Surkhet CECCs need to invest the existing fund to improve the quality of the services. The partnership is growing among the local level and national level organization for eye care services. The prevalence of the active and blinding trachoma is highly reduced in the programme area. More work and interventions are needed for the hilly districts. Implementation of Bio safety as per the SRC guideline has further improved the quality of eye/mobile camps services. Provision of a portable A Scan Bio meter have further improved the quality of service.. Problems, solutions and recommendations The security and political situation affected the productivity of some of the activities such as surgical eye camps and training programme. Patients access to the eye camps was reduced due to the unrests pre and post election and less patients were served than expected. For some of the districts bad weather was also responsible to delay and cancellation of services. It is expected that the political situation improves and leadsi to increased productivity. Due to the cancellation of flights scheduled for Humla, the cataract screening camp team could not reach in time and had to cancel some of the screening camps in September. Continuous rain and snow fall in Humla during the screening and surgical camp seriously hampered the camps carried out in collaboration with Himalaya Eye Hospital. The team was even blocked in Humla for 5 days following the eye camps as the airstrip repairing took time damaged by the rain. The CECCs in Bardia and Jajarkot need more attention and monitoring of its income management through service delivery as it can be further increased with the prevailing productivity and patients flow. CEHP s finance and eye care unit are making a regular follow up of the situation. Though the DCs have accepted the Memorandum of Understanding (MoU) to take over the overall management of the CECC, they are continuously presenting their inability to continue the appointment of the staff working in the CECC as the present benefit they get is high compared to the salary paid by the chapter for other components of services. Extensive discussion especially with Bardia DC and attempts to mediate the situation, (10)

14 was done by the CEHP authorities. This situation is possibly the result of reaction from the DC and staff members following the management change from the CEHP to the DC. This situation has also affected the CECC and outreach services in Bardia, neglecting the refraction and glass sale service pilot project in the community during the mobile camps and school activities. A meeting was held with the Secretary and the Vice President in this regard and they have assured to settle these matters as soon as possible. Cooperation with partners Tilganga Eye Centre from Kathmandu continued their support with the supply of IOLs for all camps free of charge. 475 IOLs worth of Rs. 142,500 were received during April December Surkhet, Jajarkot, Dailekh and Dolpa Red Cross chapters coordinated with various district level organizations to obtain necessary support for the cataract surgical camps. The local level organizations and VDC provided their assistance to organise food and accommodation for the patients, as well as utensils, beds, firewood, provision of volunteers, furniture and very many other logistics (tents) to make the camp success. NRCS Dailekh collected NRS 30,000 (approx) and some food grains from district and local level organizations. CEHP assured the cooperation in screening and referring cataract patients to FBEH who are to be operated at FBEH with the financial support of the Indian Embassy. Under the support of Indian Embassy, 15 collaborative mobile camps (jointly by CEHP and FBEH) were organized in Banke district. 1,690 patients were screened and 325 operable cataract cases were referred to FBEH for surgery and 316 operated. FBEH provides their ophthalmic surgeon for the CEHP organised eye camps. A senior staff member of the CEHP keeps joining the fort night coordination meeting at FBEH to ensure coordinated efforts of CEHP and FBEH. Discussion continues with FBEH to start surgical service (for cataract surgery) in Surkhet CECC. Two collaborative mobile eye camps were incorporated with the general health camp organized by District Public Health Office Banke at Mahadevpuri and Naubasta VDC and 294 patients were served. 9 people with operable cataract were referred to the eye hospital for surgery. CEHP collaborated with Humla Red Cross and Himalaya eye hospital to carry out surgical eye camp in Humla. CEHP carried out 7 cataract screening camps prior to surgical camp, primary eye care training for teachers and traditional healers and orientation to the 153 FCHVs in various locations in the district. 517 eye patients received treatments and education in the camp and 59 were operated for cataract. National Trachoma Program provided 113,580 copies of IEC materials; which include flip charts, calendar with health education messages, posters, brochures, etc. There materials were supplied to the community members in Surkhet, Dailekh and Jajarkot. The eye care activities are implemented in close coordination with District Public Health Offices, District Education Offices, Bheri Zonal Hospital, Nepalgunj Medical College, NNJS, Fateh Bal Eye Hospital, SEVA Foundation, International Trachoma Initiatives, Tilganga Eye Centre, Lions Eye Care Programme, WHO Prevention of Blindness and Deafness, Foundation Eye Care Himalaya (FECH). Outlook for 2009 CEHP will continue the eye care activities and services as mentioned above. The operation of the Bardia and Surkhet CECCs will be completely done by the DCs management. Surkhet CECC will start surgical services. A Rapid Assessment of Avoidable Blindness in collaboration with Nepal Netra Joti Sangha will be carried out in Bheri and Karnali zone. Quality improving measures will be further implemented. DCs will be encouraged to look for more local resources and also improvement of quality and diversity of the services. CECCs will be encouraged to start refraction services linking them to service diversification and income generation. More Ophthalmic Assistants will be trained on ear care. The CECCs will receive equipments and instruments to improve their quality of service. (11)

15 2) Water Sanitation and Primary Health Care Photo: Community groups members in a health education session. This programme is implemented in Bardia, Salyan, Pyuthan and Jumla districts of Mid west region. The programme covers 14 VDCs of 4 districts, i.e. 5 VDCs in Bardia and 3 VDCs each in Salyan, Pyuthan and Jumla districts. Objective 2: To improve the health status of the people by promoting healthy behaviour through local initiatives. Result 2.1: Awareness and practise about health problems at the household level is improved. Indicators: Latrine is regularly used by all household members over 5 years of age Household members over 5 years of age wash hands with soap/kharani 2 (before and after food and after toilet) in Bardia 70%, Pyuthan 60%, Salyan and Jumla 40% Result analysis: The programme promoted sanitary latrine as well as pit latrine construction in the programme VDCs. As per the PRA carried out till September 2008 shows that 42%, 54%, 78% and 58% people over 5 years of age use latrine regularly in Bardia, Salyan, Pyuthan and Jumla respectively. Likewise, 54%, 23%, 51%, 29% HH members practiced to wash hands with soap before and after food and after toilet in Bardia, Salyan, Pyuthan and Jumla respectively. One day programme concept orientation has been carried out in programme districts with participation of 71 related staffs and DCs members to share about the programme and its' implementation process. Field Coordinators (FCs) and Community Facilitators (CFs) had been trained on 6 different subjects during the phase To refresh the knowledge of relevant staffs, a 7 day refresher training has been organized with the participation of all FCs and CFs in Nepalgunj. Observation visits of 2 communities of Banke district where health and sanitation programme has been supported by NEWAH and Sahakarmi Samaj (a NGO) and a community in Bardia where Wat San & PHC programme is running has also been carried out. 2 Kharani is Nepali word for ash (12)

16 Group Strengthening The Wat San & PHC is implemented by community management through social/group mobilization. This process is facilitated at the VDC level by 2 Community facilitators (1 female & 1 male) for each VDCs. During reporting period, the Community Facilitators (CF) have facilitated 238 groups and initiated the establishment of action members and action groups within each Community Group. The action members/groups are responsible to look after specific service areas such as safe drinking water, sanitation, HIV and AIDS, safer motherhood, eye and ear care, etc. 1,190 action members or action groups have been established to promote good health behavior on the above said areas and to ensure implementation of practical actions for change in the community. PHC Sessions In order to disseminate PHC messages to community groups including action members/action groups (AMs/AGs), the CFs conducted 1,813 times various sessions on PHC. 338 sessions were carried out in Jumla, 436 sessions in Pyuthan, 298 sessions in Salyan and 741 sessions in Bardia. The sessions mainly focused on safe drinking water and sanitation improvement, safe motherhood promotion, nutrition, HIV & AIDS, eye and ear care and few other primary health care related issues at the local level. Programme district chapters have celebrated the special occasions and days i.e. National Sanitation week, Breast Feeding Week, Condom Day, World AIDS Day, etc. to sensitize and to raise awareness on the health related issues. During the occasions 33 campaigns were also carried out at community level. Before carrying out campaigns, FC, CFs including action members coordinated with relevant stakeholders and disseminated the message of campaigns from their level. During the campaigns/special days CFs conducted 304 practical demonstration sessions i.e. ORS preparation, Porridge preparation, Stretcher, Utensil stand construction, proper use of condom, etc. to promote healthy behaviors and to transfer skills to community members. In order to monitor the outcome of the various practical and education sessions in the communities, the CF's carried out various PRA sessions. The PRA carried out till September 2008 showed that sanitary latrine as well as pit latrine construction have been promoted significantly and 42%, 54%, 78% and 58% people over 5 years of age use latrine regularly in Bardia, Salyan, Pyuthan and Jumla respectively. Likewise, 54%, 23%, 51%, 29% HH members practiced to wash hands with soap before and after food and after toilet in Bardia, Salyan, Pyuthan and Jumla respectively. IEC/BCC promotion IEC/Behaviour Change Communication (BCC) plays a vital role to enhance knowledge and skills in particular areas. During campaigns, formal PHC sessions, also at casual gathering for other reasons and at the time of practical sessions the programme DCs distributed 26,868 copies of IEC materials related to safer motherhood, sanitation, HIV & AIDS, Condom, eye care, etc. to the community members. Most of the IEC materials such as sanitation related leaflets, pocket calendar, wall calendars, posters, pamphlets, HIV and AIDS related leaflets, Safe motherhood related BPP (Birth Preparedness Package) charts, Eye care related leaflets and wall calendar etc. were collected by CEHP and DCs from NFHP, National Trachoma Programme, DHO office in the districts, Geruwa Jagaran Samaj (NGO), Department of Water Supply and Sanitation in Kathmandu, NEWAH, World Vision International, Save the Children (US), NRCS HQs, etc. A few leaflets were developed by CEHP. Awareness level of the community members are also increasing. They organize and actively participate in health related sessions or activities and celebrate various national days to promote and sensitise for healthy behaviour with their own initiatives. They are collecting IECs from the local and district level agencies and use them during these events. We are happy for the latrine I am Mina K.C. (46 F) live in Kundarkhola, Chunja VDC of Pyuthan. We are weak with our financial situation, thus my parents used to live in India for work. They could not send me school and I got married in my early age. My productive period of life passed doing household cores in my village. Red Cross helped us to unite in a group and we started receiving information about sanitation and hygiene. When we learned about the problems from the unhygienic behaviour, this has opened my eyes and also made me worry as I had no money to build a good latrine. My husband was not happy to go for a pit latrine as it always gives foul smell. This made us to continue going to near by forest for defecation. Once I involved in sanitation campaign and knew that many my community people had already made simple toilets and their yard were also clean. Then I again requested my husband to construct a pit latrine but he did not agree and was even angry with me. Then, I insisted and constructed a pit latrine with the help of my sons. I started to use that pit latrine but I also didn't feel nice in the beginning. At that time, no one except me used the latrine. But later, all of my family members started to use (13)

17 that latrine. Our group meeting decided to further improve sanitation and hygiene for better health. We also keep our hands clean and I have a separate place (drying stand) to keep our utensils. Recently we have constructed better latrine with some support from the Red Cross and we all use it. Our group even helped me to join literacy class and I can write my name and a few words too. 14 billboards (hoarding boards) related to Sanitation, Safe motherhood and HIV & AIDS have been established in the programme districts. CEHP also supported DCs to broadcast PHC related messages through local FM radios and newspapers during various campaigns. PHC messages were broadcasted 8 times. Result 2.2: Safer motherhood awareness and practise improved. Indicators: Pregnant mothers receive 4 times or more ANC by skilled health care providers (Bardia and Jumla 80%, Salyan and Pyuthan 60%) Deliveries conducted by trained attendants are 30 % in Bardia, 20 % in Salyan and Pyuthan, 15 % in Jumla Result analysis: One of the major interventions was concerned with safer motherhood. During this year, 48%, 20%, 21% and 51% of pregnant mothers received 4 times and more ANC by skilled health care providers and 14%, 7%, 10% and 4% deliveries conducted by trained health workers in Bardia, Salyan, Pyuthan and Jumla respectively. Following the expected result of these indicators we reached satisfactory level only. Safe motherhood All the 238 Community groups nominated and mobilised action members (AM) or action groups (AG) within their community group (occasionally outside the group also). The AMs/AGs provide inputs on health issues and follow up and monitor the pregnant mothers' health behaviour. They visit the relevant families in the village to motivate and advise pregnant mothers and their family members for their healthy behavior during pregnancy. The Action members and other members of the community groups identify and help pregnant mothers to visit health centres for ANC and safe delivery. They also visite families and promote the importance of seeking services at the health centres during pregnancy. According to information gathered by Action Members and of the Health Posts, 770 pregnant mothers have done more than 4 times ANC check up at a health institution and 183 delivery cases were attended by skilled health workers. The CFs and many of the group members complain that the services of the health posts are very poor. 19 groups have the provision of community transport system (provision of stretcher) for pregnant mothers in place, to transport pregnant women or sick people to the health post or hospital. 73 community groups of the programme districts have started to operate a safer motherhood revolving fund. The CGs have savings of about NRs. 87,000. They use the fund as a priority to support pregnant women for safe delivery. They also support community members to receive care for other serious health related problem, in case of urgency. The fund is always provided as loan with nominal interest. There is no report of maternal death in the programme area. The CFs also provided information on health service provisions of GoN to the entire 238 groups focusing on safer motherhood services. Neighbour saved the life of Kali Rokaya Shant Rokaya of Talium VDC, Jumla has now joined the Chetana Sarasaphai community group. He was reluctant to join the group and did not allow his daughter in law (Kali Rokaya) to be involved. When other members of the group and the CF tried to motivate him telling him about the usefulness of the various activities done by the CGs he was not convinced. Shant's daughter in law was pregnant and she had bleeding and pain in the month of delivery. He called the traditional healer (Dhami) to treat her. When his neighbours, who had been to the CGs activities and health sessions, came and suggested to take her to the health post or the district hospital, he didn't agree. The bleeding did not stop and the Kali was seriously ill. The neighbours called Mrs. Tara Rokaya, Community Facilitator (she lives in the near by village) explaining her the situation. She also came immediately and requested Shant to take her to the hospital as soon as possible if he wanted to save her life. As Shant did not see much option, despite of feeling compelled, he agreed to take her to district hospital. When they reached the hospital, fortunately the doctor was there and she was helped immediately. The doctor commented that she (14)

18 would have died if they were late for half an hour. Shant felt very guilty and he changed his thinking. Now Shant joins all activities of CGs and appreciates his neighbours' role on saving life of his daughter in law. Result 2.3: Access to safe drinking water and sanitation is secured Indicators: In Pyuthan 50%, Bardia and Salyan 40 % and in Jumla 30% of the households have access to sanitary latrines In Bardia and Pyuthan 70 %, Salyan 60 %, Jumla 50 % have access to any kind of toilet 1,863 HH have new access to safe drinking water Result analysis: Extensive activities were carried out by the groups to improve access to safe drinking water and sanitation. 26%, 26%, 25% and 27% HHs have access to sanitary latrines as well as 58%, 64%, 78% and 48% HHs have access to any kind of toilets in Bardia, Salyan, Pyuthan and Jumla respectively. 360 HHs also have new access to safe drinking water. The groups has also made several changes in environmental sanitation like; cleaned and repaired road, cleaning hands before eating and after toilet. Water Project Safe drinking water is the most vital component for reduction of disease burden of the people. In the hills, its accessibility is very poor and also the quality is questionable. Thus, CEHP supports needy communities within the Wat San & PHC programme area to avail water supply. Health and hygiene education is incorporated into the PHC to improve understanding on the use and handling of drinking water. Following is the list of water systems completed and under construction in the year 2008 S.N Name of district Name of system Name of village, VDC No. of beneficiaries HHs (people) Date of start Date of completion Gravity Flow 1 Jumla Pipaladi Hiyakhola, 66 (370) May 2008 Oct 2008 Lamra 2 Jumla Sidhhumul Kotila, Talium 72 (483) June 2008 Nov Jumla Ranka Ranka, Tatopani 171 (889) Nov 2008 Expected in Mar Pyuthan Paharafute/Banna Banna, Chunja 15 (119) Oct 2008 Expected in Feb Pyuthan Rajughat/Barrabot Barrabot, Chunja 20 (114) Oct 2008 Expected infeb 2009 Spring Protection 6 Salyan Khatipandhera Nigane, 55 (302) Aug 2008 Nov 2008 Phalawang 7 Salyan Chhetrebaj Chhetrebanj, Phalawang 21 (126) Oct 2008 Expected in Feb Salyan Majhajula Majhajiula, Kabhra 18 (96) Oct 2008 Expected in Feb Salyan Lamidada Lamidanda, Kabhra 19 (85) Oct 2008 Expected in Mar Salyan Thutepipal Thutepipal, 23 (131) Aug 2008 Sep 2008 Phalawang 11 Pyuthan Bukeni Bukeni, 49 (282) Sep 2008 Nov 2008 Dharampani 12 Pyuthan Chaurpani Chaurpani, Raspurkot 95 (610) Sep 2008 Dec 2008 The District Developmetn Committee (DDC) in the district is official authority to approve and coordinate the use of water sources in the community. In order to start the construction of water schemes registration of the water user committees and water sources were done at the District Development Committee's water source management sub committee by the community members with the support of community facilitators and District Chapter. (15)

19 3 days construction and fund management training for users committees have been conducted in Jumla, Salyan and Pyuthan (1 time in each district), 65 user committee members participated in the training. Trainings were facilitated by Junior Engineers of CEHP and Field Technician of DCs. The DCs Jumla, Salyan and Pyuthan (1 time in each district) have conducted 7 days training to caretakers on water scheme maintenance, 39 participated in the training and they got knowledge and skill about maintenance of water schemes. Photos: Construction of a water scheme by the community members in Jumla district. [In the photo the community members are digging earth to bury water pipeline that connects water source to the water collection tank, shown in the right side. The community members also take responsibility to organise local materials such as sand, aggregate, unskilled labour, transportation of material from the airport or from the main road to project site to construct the water projects.] One village located in Chunja VDC of Pyuthan will have support from the DDC and District Water supply office to construct rainwater harvesting systems. No request has been received from Bardia district for the need of hand pumps. Since Bardia lies is the Terai (low land) almost all villages have good access to drinking water. Sanitation The practice to manage household and human waste is very poor and the level of awareness about the benefit of improved sanitation is very low in the communities from rural areas. Only a few families use latrines. Therefore, transmittable diseases, mainly the diarrhoea diseases, occur in abundance. Improvement on sanitation is a part of the Wat San & PHC programme. During this period, various community activities took place for sanitation behaviour improvement. Through the facilitation of the CFs, the community groups and action members/action group from Bardia, Pyuthan, Salyan and Jumla districts frequently carried out sanitation improvement campaigns in the villages to prevent open defecation, promote the construction of toilets and the proper use and cleanliness of existing toilets. They shared the importance of toilets and shared the provision of subsidy to construct sanitary latrines. Community group members have constructed 2,279 latrines. Out of this 1,642 families have constructed a sanitary latrine, subsidized by SRC funds. Community groups did a well being ranking and ranked their households according to assets and resources. Afterwards, the project determined the amount of subsidy for each class depending on the well being ranking. Only materials were subsidized, labor and local materials like stones had to be managed by the households. This resulted in access of sanitary latrines to 26%, 26%, 25% and 27% HHs in Bardia, Salyan, Pyuthan and Jumla respectively, and access of any kind of latrines to 58%, 64%, 78% and 48% HHs in Bardia, Salyan, Pyuthan and Jumla respectively. Demands for sanitary toilets were much higher than expected and thus more budget allocated to toilet construction. People are well sensitized towards the advantage of toilets. Some community groups are also interested to declare their area as open defecation free community. Some of the families who had collected materials from other agencies free of charge for the construction of latrine in the past were motivated to finally install and use them. It was a bit difficult for the CEHP project to work only with software as the communities around were already spoiled by the hardware oriented development projects in the past. Despite of small provision of hardware (16)

20 through CEHP, community memebrs are gradually encouraged by collective development. They are becoming more and more interested to join the CG's activities as they could see the benefit for their community through information, education and collaboration for software and hardware provisions. The CGs started to realise that they can achieve much more if they work collectively. Photos: Community members are more and more interested in sanitary toilets. The CG members also initiated various other activities. 562 HHs constructed utensil stands made by bamboo to sun dry their utensils. 208 HHs dug waste pits to manage household wastes. Other communities were cleaning their footpaths, did road works, forestation, etc. During the 9th national sanitation week, Pyuthan chapter got the first prize among the working institutions in water and sanitation activities in Pyuthan. The programme was organized by District Drinking Water and Coordination Committee. The Prize was Rs. 1,500 in cash and a certificate. Result 2.4: The capacity of the community groups is developed towards self reliance. Indicators: 5% of groups reach stage A of self reliance, 50% of the community groups reach stage B of self reliance, and 45% of the community groups move towards stage B Result analysis: A tool was developed to assess the capacity of community groups. The internal assessment was carried out and an external assessment is in process. The internal assessment categorised 49% of CGs to B and 51% to C levels for their status. Self reliance of community groups In order to provide systematic input to the CGs, the programme developed a Community groups' capacity assessment tool, to be used on an annual basis. It consists of 7 parameters and 25 Indicators. After the initial introduction of the tool to the CFs, the CFs facilitated the self assessment of the groups capacity. Following table shows the status of the CGs: Status District Bardia Pyuthan Salyan Jumla Total % Total Groups >=81 (A) >=51 (B) <=50 (C) Analysis of the self assessment shows that most of the CGs have active action members/groups and the CGs feel that they are serious on their responsibilities. Tthere is good participation of the group members in the meetings, they discuss participatorily and decide by reaching a common consensus. The CGs also record the decisions in the minutes. The CGs further express that they have practice to settle internal conflicts on their own and there is also a proportional participation of female, Dalits and indigenous peoples in the groups who have also the key role on decision making. In the self assessment the CGs also indicate that they have a lot to improve as most of the CGs are still not clear on their vision. CGs are still not registered with the concerned authorities. They are also not regular on (17)

21 organizing an annual assembly and are still weak on operating finances through bank accounts. They also indicate that their coordination and links with local and external agencies is still weak and need a lot of improvement to have better access on resources from such agencies. The assessment helped CG themselves and the CFs to identify weak areas or its status of each indicators. This has made easy for FCs to focus their input for improvement. The CFs all the time carry assessment information of each CGs in a diary, so that they could facilitate to improve specific indicators. Well being ranking of all HHs within the programme VDCs were carried out by the CGs in order to focus input and contribution to weaker section of the community. At the moment the DC and CGs are using this information in the context of subsidy provision for latrine construction. However, they may also use this base as information for any other relevant projects they carry out in future with CEHP or from outside support that requires wellbeing status. Main results of self evaluation The introduction of the concept of action members/groups became fruitful as the AMs have seriously taken responsibility to work for a particular issues. They help community members by working as mediators to share the health message of a particular subject to the community members and bring problems or issues for discussion in the meeting. With the support of AMs, the rate of ANC is increasing as well as sanitary latrine construction is going on smoothly. Wat San & PHC service has started to be visible as development work of Red Cross in the community, due to positive impression of the services, the local stakeholders (GOs/NGOs) are becoming eager to work together with district chapters. Linkage building is also improving day by day with various stakeholders. This will help DCs to tap resources and cooperation at local level. Photos: Sun drying utensil stands. Extensive input of DCs on education and demonstration related activities to promote latrines in the communities, has given tremendous sensitisation on the need to improve sanitation. Extensive input of DCs on education and demonstration related activities to promote latrines in the communities, it has also given tremendous impact on the need to improve sanitation. Problems, solutions and recommendations Due to the frequent absence of the health post and sub health post in charge and the Auxiliary Nurse Midwife (ANM) and the lack of materials in the health post, pregnant women can't avail ANC check up and delivery services properly and timely at community level. This problem is more serious in the remote areas hilly districts than in the Terai. The situation has been verified by CEHP staff by direct visits to the Health Posts/Sub HealthPost as well as by interviews with health staff and community members in the programme VDCs. For the solution of this problem, support to the existing HFOMC (Health Facilities Operation and Management Committee) seems to be the most appropriate and sustainable way of improving the health service provision at VDC level.. ADRA and Merlin are implementing an intervention plan to strengthen the health system management by communities themselves in Salyan and Pyuthan. CEHP will be able to collaborate with these organizations in their service VDCs. This initiative requires a synthesis of efforts with the government health institutions and all supporting agencies from the community to the district level. District Chapters and Sub Chapters shall also be involved in this plan because they can play an important role especially in the follow up stage. On the other hand, it is important to raise awareness on poeples right to health among the community members through the regular sessions. (18)

22 Bad weather and road blockade due to landslides caused serious interference and delay on construction of water projects in the year It was further delayed because of the low temperature in Jumla and also because of the high turnover of technical (overseer) staff members since some of the organizations offer better financial benefit to experienced technical staff members. However, this problem is ended at the end of the year when CEHP started assigning 2 junior engineers in the CEHP. The construction of Rainwater harvesting system was delayed because CEHP did not get experienced technical staff member for this work in the initial stage; which even caused error on planning, as communal use of Rainwater Harvesting was already a failure. The plan was revised later to construct a Rainwater harvesting system per individual household with a collection jar at household base. The start up was further delayed by seeking more funds to cover all households of the villages. Eventually the DDC and a NGO in Pyuthan showed interest to co finance. A proposal (including plan and costing) was submitted to the DCC Pyuthan and is it expected that the construction can start in Many sanitary latrines have been constructed with subsidy approach but most of the community members want them free of cost. Community people of category 'A' who don't get any subsidy according to the subsidy approach, are not accepting the result of well being process, even though they have been the ones to determine the well being ranking. CFs are motivating the community people of category 'A' to construct sanitary latrines without subsidy and some of them do. Disputes among community members and the project arose regarding the amount of materials and quality of materials given by the project. Even though the materials have been estimated by the project engineer, the communities had to be revisited again and explained the procedures and calculations to them. The estimate for cement for sanitary latrine was slightly increased for Salyan district. Cooperation with partners/stakeholders Mr. Kamal Baral and Mr. Hari Subedi participated at meeting with the authorities of NRCS Salyan and district manager of GTZ, Salyan in order to explore the possibilities to integrate GTZ program in the Wat San & PHC implemented by NRCS Salyan. Jumla Red Cross chapter integrated food for work activity/service in the construction of water scheme project (Hiyakhola and Sidhumul GFWS). The food to the DC was provided by WFP and DC provided food/rice to community people as their daily wages who were involved in digging the water pipe line. Bardia DC coordinated with community forest users committee (Bhawani Community Forest Mohammadpur VDC, Rammapur Madhyawarti Community Forest Magaragadi VDC, Jansakti Kareliya community Forest Padnah and Dhakaila Madhyawarti Community Forest Dhadhawar VDC, Watawaran Sarokar and Madan community forest users committee) to search support for subsidy to construct sanitary latrines. They provided financial support for 570 sanitary latrines on the basis of well being ranking. Pyuthan, Jumla, Salyan and Bardia DCs carried out district level coordination meetings with all stakeholders of the DC and VDC level. Achievements of (including Jan March 2008) and the target of had been presented in the meeting. Most of the representatives committed to work with the Red Cross in similar activities. Programme DCs coordinated with local institution District Health Office, Youth Club, VDC, Health/Sub Health Post, District Health Office etc. to celebrate special days, receive health services and distribute IEC materials. CEHP coordinated with the Nepal Family Health Programme (NFHP) for safer motherhood related IEC materials to provide all FCs, CFs and community groups. NFHP representative Mr. Prem Khadka and Mr. Raj Kumar Kshetri of CEHP visited the programme area of Salyan to observe and explore the community mobilization intervention. Their discussions were focused on understanding the CGs future plans, activities, their ways to generate fund, level of understanding on reaching towards self reliance, etc. Some of the CGs presented need for literacy classes and requested support. They also visited the District Health Office (DHO), ADRA Nepal, GTZ/PASRA, Dalit Development Society and EIGCM (19)

23 (Education for Income Generation and Conflict Mitigation) and discussed to improve the health service system and also explored the possibilities to work in programme areas collaboratively. Outlook for 2009 The CEHP will continue working in the above mentioned areas in the year Attempts will be made to improve the services of the community health centres (HP/SHP) and their links to the communities will be strengthened coordinating with DHO, VDC, and other relevant stakeholders. The community facilitators will focus on the capacity building of the community groups with the aim of gradually handing over of facilitation and group management to the group leaders so that the groups become independent. More water projects will be carried out including rainwater harvesting. CG's partnership with local level institutions such as DDC, VDC, Health post, NGOs will be further promoted also in the sanitation sector. (20)

24 3) HIV and AIDS Prevention The school based HIV peer education programme is implemented directly by Red Cross chapters in 8 districts (Dang, Dailekh, Jajarkot, Rukum, Salyan, Pyuthan, Rolpa and Jumla) and HIV prevention activities are also integrated in 238 Community Groups of the Wat San & PHC component in Bardia, Salyan, Pyuthan and Jumla districts in Mid west region. Photo: Students participating in a interschool HIV prevention Quiz. Objective 3: To reduce the vulnerability to HIV and its impact in the Mid West Region Result 3.1: School based HIV peer education programme to prevent further infections is consolidated and institutionalised. Indicators: 69,600 students in 8 districts are reached by peer education. 60% of the follow up schools developing annual plan, carrying out HIV activities and submitting reports to DCs as per annual plan. 25,000 students directly reached by IEC activities. Result analysis: 36,245 students (52% of total target) in 8 districts were reached in this year. Further reach will be made in year 2009 and (36.5%) follow up schools reported that they submitted reports of HIV activities to DCs as per their annual plan in the year ,835 copies/sets (83%) of IEC materials were provided to the students, this includes IEC materials received from various other stakeholders. School based HIV Peer Education The programme has been implemented in 180 schools in 8 districts. Compatibility with Global Alliance on HIV and AIDS in the programme components have been ensure while planning. In year 2008, a lot of focus was given on institutionalisation of the HIV prevention and awareness programme in schools. The direct support for the staff members at the DC level has been stopped and the programme management role has been taken up by the volunteers or chapter's regular staff members, who have already been trained by CEHP to manage HIV prevention and peer education at schools. Each district chapter has nominated a Focal person for the HIV and AIDS programme for smooth implementation of programme. In order to disseminate the changed programme management role of the DC and its network, all programme district chapters organised an orientation meeting for DC, sub chapter and Junior Red Cross /Youth Red Cross (J/YRC) leaders. 180 members from 8 districts participated. The representatives were familiarized with the program approach, the objectives, the activities and the importance of the institutionalization of the PE program in schools as well as oriented on the present situation of HIV and AIDS in the country. As a part of the institutionalization process, the District chapters also carried out meetings with the members of the School Management Committee (SMC). Trained volunteers of DC facilitated 196 meetings with SMCs to sensitize them on the current situation of the HIV and AIDS in the nation, the impact of HIV and AIDS on the national development, public health and others sectors, the importance of a functional prevention program in (21)

25 the school level, and the role of SMCs in preventing further infections. The main aim was to ensure the continuation of the HIV and AIDS activities in the schools as per J/YRCs annual plan. The J/YRCs district assembly was conducted 6 times in the programme districts of Jumla, Jajarkot, Rukum, Pyuthan, Dang and Rolpa. All together 451 students from Junior and youth Red Cross Circles of 157 schools participated in the assembly to make the annual plan of J/YRCs. The schools presented the annual report of various activities including HIV prevention carried out by them during the past year. The annual plan of activities of J/YRCs District committee was prepared by the assembly for next academic year. The main components were HIV and AIDS prevention, First aid, Disaster preparedness, Membership promotion, etc. In the programme districts, 149 schools have included HIV prevention activities in their annual plan and implemented them accordingly to ensure their institutionalisation. A half yearly review meeting was organised in November at Nepalgunj with the participation of volunteers staff members of CEHP. Emphasis was given to further enhance the understanding of the institutionalization process of HIV program at schools. However, all DCs underlined that it was early to cut the staff support for the DCs and the duration for institutionalization was also set short. Following request from CEHP, Mr. Bipin Ranjit, Coordinator of Nava Kiran Plus, Nepalgunj facilitated sessions on sharing his HIV positive life and GIPA (Greater Involvement of PLHA) concept to enhance understanding of the participants on how DCs could involve PLHA on HIV prevention and stigma reduction activities. Action plan from the schools and follow up The DCs are continuously working to encourage schools to submit their annual plan of action to DCs. Volunteers of programme DCs visited the follow up schools to ensure implementation of the activities as planned by the schools. 142 schools had reported to DCs about their performance on HIV programme. DC's representatives joined 63 schools level review meetings to monitor HIV activities carried out at the school level. DCs representatives also made additional follow up visits to programme schools for 181 times in ensuring activities run by the J/YRCs. J/YRCs conducted school level activities like quiz competition and essay competition in some Friday sessions as extra curricular activities. Querries discussion is carried out on monthly basis in the schools. J/YRCs utilize fund of them generated by membership fee. Fund raising was also done in some schools by during local festival. Some schools provide the logistic support for the program organised by J/YRCs. Training carried out by DCs DCs organised 6 Training of Trainers (ToT) for 115 Teacher Sponsors in Jumla, Rolpa, Rukum, Pyuthan, Salyan and Jajarkot. The objectives of the TOT is to develop trainers in the field of HIV/AIDS, STIs and RH in each programme districts in order to develop peer educators and disseminate accurate factual information on HIV & AIDS, STI and RH to students as well as to community people. Following the ToT, the trained Teacher Sponsors carried out 115 times Peer Education training in programme districts through which 2,312 peer educators were developed. DC also organised planning and review meetings for 19 times with participation of 527 teacher sponsors in the programme districts. During this meetings the teacher sponsors proposed plan for their school on HIV activities to be implemented for a year. In order to transfer peer education skills among the other students of each programme schools, the trained PEs with the help of trained teacher sponsors carried out 1,727 interaction sessions on different topics focusing on HIV & AIDS prevention and RH. Total of 8,662 students received information on Reproductive Health (RH), STIs and HIV & AIDS. The programme schools also carried out 1,384 sessions for queries discussion where 23,955 students participated to listen to the answers. Programme districts chapters have organised 17 events and competitions i.e. folk song, essay writing, drawing and drama to sensitise people HIV and AIDS and to reduce stigma and discrimination. Total of 1,378 students from different schools participated in those events/competitions. CEHP also provided IEC materials and radio messages to disseminate preventive measures on trachoma and other eye diseases. CEHP has distributed 111,131 copies of IEC materials related to trachoma. During various activities 7,119 brochures and 6,038 posters were also distributed to various members of the community. (22)

26 IEC materials provided by CEHP were mainly focused on life skills, HIV/AIDS and Reproductive Health issues. Some materials were related to peer educators i.e. peer diary, batch, life skill guidebooks etc. CEHP supplied 9,450 Yoba Chautari (Quarterly publication of NRCS HQS related with queries and issues of HIV & AIDS) to the programme districts. Altogether 20,835 students received IEC materials in the programme districts. Pyuthan district carried out HIV and AIDS awareness sessions in 14 schools for 701 students incorporating with Humanitarian laws and Red Cross dissemination. Result 3.2: Further infections in the community in 4 districts are prevented through greater awareness and promotion of safer sex behaviour. Indicators: 80% of sexually active male population are using condom for safer sex. 60% of community people know four modes of transmission of HIV. Result analysis: The above mentioned result indicators are evaluated through KAP study at the end of year Promotion of Safer Sex Behavior Behaviour Change Communication training on HIV, STIs and RH was conducted in 4 programme districts (Salyan, Jumla, Pyuthan and Bardia) for 28 CFs of Wat San & PHC component and 7 additional persons of programme chapters. This has helped CFs to pass BCC to the action member/action group members of HIV and AIDS formed by the Wat San & PHC component in 4 programme districts for effective dissemination of knowledge on HIV and promote behaviour change at family level. There are already 168 Action Member/Groups within 238 Community Groups and more will be nominated next year. All together 370 sessions on HIV and AIDS were conduced in community groups and 6,415 members participated in the sessions; total of 168 Condom demonstration sessions were carried out in the community group to provide knowledge of correct use of condom. Photo: Red Cross facilitator in a RH session. Orientation on condom social marketing was organized in Salyan, Bardia, Pyuthan and Jumla district chapters with the facilitation support of Nepal CRS Company. All together 83 grocery shopkeepers from 14 programme VDCs covered by Wat San & PHC component of CEHP participated in the orientation. Every Grocery shopkeepers were provided a stock of condom to start sell to improve accessibility. Follow up on the availability of condoms from those shops/outlets will be ensured by CRS Company. During local events 18 street dramas on HIV & AIDS to sensitise people HIV and AIDS and to reduce stigma and discrimination were conducted in Jajarkot, Rukum, Pyuthan, Jumla, Salyan and Rolpa districts were observed by 5,216 people. Result 3.3: Access to information and services for treatment, care and support is promoted. Indicators: 300 PLHIV supported for accessing services. 1,200 people referred to VCT. At least 1 Support Group in all 8 districts exist and the identified PLHIV are linked to them. Result analysis: 67 PLHIVs (100 was the target) were financially supported and 166 cases (400 was the target) were referred for Voluntary Counselling and Testing (VCT) during this year. Referral target could not me met due to lack of VCT facilities in some of the programme districts. Since 2008 December VCT centres are operated by (23)

27 other organisations in every programme districts except in Jumla. So, there is possibility of increasing referral cases to VCT and ART in the following years. There are support group (SG) in 5 programme districts and a SG of Pyuthan is formed with the initiation of DC. Support to PLHIV Since this year, the programme focussed on identification of positive cases, de stigmatisation and linking positive people to existing services and self help groups. 166 persons were referred to Voluntary Counselling and Testing (VCT) centres for testing and 67 PLHIV were financially supported to access CD4 count in Kathmandu or Nepalgunj. There are support groups in 5 programme districts and a SG of Pyuthan is formed with the initiation of DC. 2 PLHIV are linked with Support Group. The programme also started the greater involvement of positive people in the capacity building and during international day and public events. National Condom Day & World AIDS Day In October, with the slogan of ''Universal Access for Dual protection", the 14 th National Condom Day was organised jointly with other line agencies working for HIV & AIDS in Nepalgunj. During the day, quiz competition, rickshaw rally and blood donation program were also organized. Staffs member of CEHP participated in the rally. A cross boarder information centre was established at Jamunaha, Nepalgunj border to India, for a week. Condom and IEC materials were distributed from the information centre to the people returning from India. 500 leaflets, 6,500 condoms and 500 slogan printed paper caps were distributed to the travellers. Those materials were supplied to CEHP by DHO Banke and NRCS HQs. Additional 6,000 condoms supplied by DHO to CEHP were also distributed during the activities. The day was celebrated in the community groups for a week as a campaign. CEHP supplied 14,000 condoms to Bardia, Pyuthan, Salyan and Jumla DCs coordinating with Nagarjun Development Community (NGO). Condom was provided to community people to make them familarize on its importance, reduce various barriers and stigma related to condom. During the day, the DCs also organised radio messages broadcasting through the local FM radio stations of above four districts and in Nepalgunj for one week. 21 st World AIDS Day, with the slogan of "Lead, Empower and Deliver, Stop AIDS, Keep the Promise" was also jointly celebrated in Nepalgunj organising various sensitization activities. CEHP and 27 other organisations participated in the celebration. My Experience after HIV and AIDS Training I am Kamal Bahadur Chand from Jajarkot. During my schooling, I didn't have knowledge on HIV and AIDS because I did not participate in the Junior and Youth Red Cross activities. Whenever I heard about HIV and AIDS, I became afraid. In the college, I was frightened to hear that HIV could not be treated. When I hear about HIV and AIDS situation through media, I was further afraid of future situation of our society. I wanted to know more about HIV, but I did not dare to ask about it thinking that other may suspect on why I was asking questions on HIV. As I started to collect information on HIV by newspapers and books, I got to know that the main transmission occurs through sexual route and weight loss and weakness may be the signs of this disease. Whenever I saw thin and weak person, I started thinking that they must be from AIDS. During those day I happened to apply for a post of administration in Jajarkot DC and got selected. After I joined the DC, I got familiar with the DC's programme including HIV prevention, that provided me to join a training program on HIV and AIDS. The training was an eye opening experience for me as my all doubts were clarified. I became confident about HIV as this is a kind of virus and the PLHA can stay without symptom for years and it was important that we talk about HIV rather than hesitating. The PHLA need loving environment and I feel that we can control this disease if (24)

28 we want so seriously. I now knew that PLHA can work like others. If the social support is given to PLHA, they can live long and happy life as others. Nowadays I discuss about HIV with my villagers especially returnees from others countries. I help them to be aware on HIV and importance of HIV testing. I thank Jajarkot DC for this opportunity. Kamal Bahadur Chand, Jajarkot Main results of self evaluation 149 (36.34% of EOP) schools institutionalized HIV activities incorporating them into annual plan. A total of 420 schools (including 300 schools up to 2007) within program districts had been reached through the School based peer education which had a positive impact on the openness to talk about sexual and reproductive health among school youths and teacher. This also helped them to clarify doubts and misconceptions on reproductive health and HIV. Since the youths of schools got the opportunities to participate in interaction session and queries discussion sessions which also help in increasing initiation and activeness of youths in extra curricular activities. 420 (including 300 schools up to 2007) lower secondary and secondary schools of program DCs have trained teacher sponsors to facilitate HIV and Reproductive health sessions. The programme has given immense support in extending Red Cross networks of DCs establishing J/YRCs in every school of the programme DCs. Some of the DC got the additional project with the facilitation of CEHP and the capacity developed by the DC itself on HIV programme management. Red Cross Chapter could support/contribute to most of the PLHA in the districts in need of access of ART, OIs management and CD4 Counts. There is still need to give special emphasis on training for new students to replace the graduated number of peer in the school by their own mechanism. Photo: HIV and AIDS related street drama. Problems, solutions and recommendations There are low cases of report on referral of cases for VCT than 400 as targeted this year in the project districts. This is due to potential cases did not go for VCT because of lack of VCT centres. Some of the program districts are continuously approaching CEHP and making request for scaling up HIV programme also to additional target groups in the community as transmission of HIV to youth and housewife is in alarming situation because of increasing trends of infection as per data of National Centre for AIDS and STI Control (see Annex 3). Most of the time the DCs wanted to be dependent on the staff members to manage the programme, thus in the initial months of the year, lack of staffs to look after the HIV programme in the DCs created a gap to monitor and follow up schools on the regular basis. (25)

29 Cooperation with partners/stakeholders There is regular link and coordination with the other organization working in HIV and AIDS program in Banke and in the programme districts e.g. DPHO Banke, NDC Banke, Western Stars Nepal, Institute of Community Health (ICH), General Welfare Pratisthan (GWP), Navakiran Plus, Hope Nepal, UNDP. All programme DCs organized a coordination meetings to seek cooperation and collaboration from the line agencies and also to brief on the HIV/AIDS prevention project supported by CEHP to them. There was presence of 158 participants from various line agencies, like DAO, DDC, DPHO, District Hospital, DEO, WDO and I/NGOs including representatives from active local clubs. CEHP also regularly participates in the DACC meetings in Banke and maintains close links with NGOs managed by PLHIV. Photo: Students in a RH session. Nepal CRS Company, a leading private company in the field of contraceptives has provided support to CEHP by availing a trainer for Condom Social Marketing Orientations organised in Salyan, Pyuthan, Jumla and Bardia district Chapters. CRS paid facilitation fee of the trainer and supplied IEC materials including some condom promotional materials. Outlook for 2009 Institutionalization of HIV programme in 120 Schools in the programme districts Meeting with school management committees of each 20 follow up schools Assistance to J/YRCs assembly of each programme districts TOT for teacher sponsors of 70 new schools of 4 programme districts Peer Education training for students of 70 new school of 4 programme districts Series of interaction and queries discussion sessions in schools Organisation of interschool competition on against Stigma and discrimination related to HIV and AIDS Organisation of street drama on HIV and AIDS Support to PLHIV for accessing services and treatment Integration of HIV and AIDS activities with Eye Care and PHC programme Involvement of PLHIV in the community and School level activities and Encourage DCs to promote fund raising activities by the J/YRCs to carry out HIV activities (26)

30 4) Organizational Development (OD) The NRCS has an extensive network in the country at the district and community level with district chapters in every district and sub chapters at the communities. CEHP is helping to carry out assessment on organisational capacity of the district chapter using participatory approach since The process is called Institutional Capacity Assessment Process (ICAP). Objective 4: To strengthen the NRCS organisational and management capacity towards becoming a well functioning NRCS Chapter Result 4.1: ICAP is institutionalised and Plan of Action of the Chapter based on ICAP elements is developed and implemented. Indicators: DCs ICAP overall status improved by 25% by 2010 DCs planning and implementation status improved by 40% DCs good governance status increased by 30% DCs office management status increased by 45% Result analysis: The over all baseline of the ICAP status was 49%, though there is no change in the first review/follow up assessment carried out by the DCs with CEHP facilitation. Harmonize and develop a common framework CEHP is continuously working to promote a common tool to assess capacity of district chapter in order to make a systematic chapter development plan and implement it to achieve status of well functioning DCs. NRCS HQs uses CAPI tool to assess capacity of the DCs. Attempts have been made to incorporate all possible indicators of the CAPI into the ICAP to harmonise the content of both tools. Further efforts will be made to sit together with the NRCS HQs to come to consensus for a common tool to be applicable at national level. The updated ICAP has 10 parameters 3 and 116 indicators for assessments. The ICAP manual (a comprehensive facilitation document written in Nepali language) has been shared to the NRCS HQs. Following the recommendations of the evaluation, the CEHP has worked out a monitoring and evaluation (M&E) framework with the help of an external consultant in the month of April. This M&E framework has been implemented and followed right from the start of this phase and will be reviewed in the beginning of Monthly reporting from the field to the CEHP base and SRC headquarters follows strictly the M&E guidelines. There was participation of all key staff members (16 staff members) from CEHP base and programme DCs. The Monitoring & Evaluation workshop also provided opportunity to further analyse each indicator mentioned in the planning matrix through computing formula, establishing benchmark, etc. This process also provided a comprehensive understanding on the data collection plan, the information flow and the prioritisation of the users of such information. The participants discussed and developed adequate tools for planning, review and monitoring. This process helped to improve the data/information recording tools and helped to avoid unnecessary data collection. The M&E framework, has been shared to all staff members and concerned volunteers in the DCs during the programme planning orientation meetings. 3 The parameters are Office Management, Resource mobilization, Networking, Finance Management, Gender, Communication, HR, Good governance and Monitoring and Evaluation. (27)

31 Photo: Red Cross volunteers in an ICAP Workshop. Development of ICAP Plan ICAP TOT: Each DCs has nominated an OD focal person to look after the OD/capacity building activities of the chapter. The focal person is responsible to monitor the implementation of the comprehensive ICAP plan and coordinate with stakeholders to raise resources. CEHP carried out a 5 day ICAP TOT in Nepalgunj to further strengthen the capacity of the OD focal persons of 12 district chapters from the Mid West region. During the training all participants set goals to enhance the capacity of their respective district chapter in a yearly basis. This trained focal person will assist the review of their chapter's status on a regular basis. ICAP Workshops: 3 District chapters, Bardia, Surkhet and Dang organized ICAP workshops for 55 participants. The baseline status of Bardia, Surkhet and Dang was 51.39, 52% and 42.19% respectively. During the workshops they prepared 3 years comprehensive plan of actions. CEHP provided facilitation support for the workshops. Review Workshop: 6 DCs Rolpa, Rukum, Dailekh, Pyuthan, Jajarkot and Kalikot have organized ICAP review workshops. They discussed on the achievements and revised their plan and prepared 3 years comprehensive plan. There were 86 participants (16 female) during the review and planning workshop. Please see table for score details. The DCs have nominated OD Focal Person who is trained on ICAP. S/he is responsible to monitor the progress as per plan discussing with their team member internally. OD unit of CEHP also monitors improvements on OD situation as per the ICAP parameters in an annual basis. District Baseline 2008 target Achieve Remarks in % 2008 in % Dailekh Jumla not reviewed Pyuthan Humla not reviewed Jajarkot Rolpa Rukum Kalikot Salyan not reviewed Dang New DC Bardia New DC Surkhet 52 New DC Overall % (28)

32 The above table shows a decreasing status of most of the DCs. This situation has been widely discussed among the facilitators and DC representatives and the following reasons were commented. During the initial assessment there was no in depth discussion to understand what each indicator means. Most of the participants were generously giving high scores during the initial assessment to prove that their status is high. They realised in the next session that their previous practice was not useful for them. Changing facilitators in some of the district chapters also shown impact on score. During the initial assessment the information given by the DCs was not verified in most of the cases, however, in the second assessment information were verifies asking for facts and figures. Considering all these reasons we concluded that the score from the second assessment gives the actual baseline status. Conflict management workshop: Conflict Management workshops have been organised at Rolpa, Salyan, Rukum, Pyuthan, Dailekh, Bardia and Surkhet districts to promote skills and understanding on conflict dynamics and on mitigation techniques. The workshop was designed for NRCS Subchapters' representatives and teachers of the concerned districts. There were altogether 157 participants including 45 female in the 8 workshops. All the workshops were facilitated by the DC's trainers on Conflict management, who were trained by CEHP in the past. Training on Resource Mobilization at DCs: Surkhet and Pyuthan chapters conducted a 2 days Resource Mobilization workshop with the participation of 22 and 12 DC officials respectively. Following the training, both DCs started to collect registration fees from the participants as an example of resource mobilization in order to establish a Human Resource Development Fund in the chapters. In a first attempt Rs. 1,000 were collected and the fund reached Rs. 5,000 by December 2008 in Surkhet. Both chapters developed a fund raising plan to meet out the activities planned during the ICAP process. Need based support and facilitation: CEHP provided a need based facilitation support for capacity building activities of the district chapters. CEHP facilitated a basic training on organizational development for the volunteers from 15 subchapters in Surkhet DC with 17 participants including 2 females. CEHP also facilitated a 4 days Basic Proposal Writing Training for 15 subchapters' representatives, including 2 females. Following the training the participants wrote 5 separate proposals and submitted to NRCS Surkhet as a part of their practice. They also developed annual work plan to use their knowledge and skill in further practice. The DC will monitor the progress on it and report to CEHP. NRCS Dang also received support by the CEHP for an orientation on Organization Development and Institutionalization of HIV and AIDS for 22 Sub chapters representatives, including 4 females. Please refer annex 4 for further info. Male counterpart had realization "Now, we are very happy after the construction of toilet for female" said one of the female executive members of the NRCS Surkhet Chapter Ms. Sabitra Paudel. She further explained that they had to face a lot of problems and were embarrassed to use a single room toilet in the chapter. She also added that it was difficult for females especially during the period of training, seminar and meeting. "We were sensitized about the gender situation through the ICAP workshop as gender is one of the parameter of the ICAP. Discussions on gender made the male counterpart realize the need for a separate toilet for females", Mrs. Bishnu Gyawali, Vice secretary of the chapter said. The Surkhet Chapter had organized a 4 days ICAP in collaboration of CEHP. "It is fully participatory, and we found ICAP a powerful tool to find out status of our chapter" said Mr Lila Ram Subedi, chairperson of the chapter. Mr. Dev Gautam, Secretary of the chapter added that the chapter will continuously implement the action plan developed during the ICAP workshop and the construction of a new toilet is just one example. Support to Develop Project Proposals: CEHP supported DCs to prepare project proposal to submit to other donors. Rukum, Rolpa, Pyuthan, Salyan, Dang, Dailekh, Jajarkot, Humla and Mugu district chapters were helped to prepare proposals for UNDP on HIV to provide a Comprehensive Package for Migrants and their Families. Among them the DCs Rukum was successful to win the project. Following a request from the Rukum DC, Mr. Hari Subedi was sent to Kathmandu along with the DC representative to help negotiation and finalisation of the cooperation agreement with UNDP to start the project. (29)

33 CEHP also supported Pyuthan, Dang and Rolpa chapters to prepare an Expression of Interest for implementation of HIV and AIDS comprehensive Package for migrants and their spouses. Pyuthan DC had been selected by the donor organisation to submit a detailed proposal. The CEHP team provided further help to prepare the detailed proposal and was successful to receive the project. Similarly the CEHP team also provided technical support to the Dailekh district chapter to develop a proposal on prevention of HIV among the youths and adolescent asked by DACC and GTZ, however without success. Publication of Chetana Bulletin: CEHP continues publishing the quarterly publication of Chetana (Consciousness) Bulletin covering various information about the project and district chapters. This publication is also helping to disseminate Red Cross movement. The bulletin mainly covers experience sharing success stories and lessons learnt from the communities and branches to various stakeholders and beneficiaries on project activities. All programme units provides support and materials to publish this bulletin. Website management: CEHP s website was periodically updated. Transversal Themes The project made an extensive effort to interlink all services of the core areas. The program orientation of all components were conducted jointly with Wat San & PHC, Eye Care, HIV prevention and OD in all programme districts. The staff and volunteers were oriented on the performance reporting and result reporting formats. CEHP funded staff members at the DC were reduced. Only one staff per DC remains and takes responsibility for all components while monitoring the projects in the districts. The inter unit sharing in the CEHP was further improved and regular staff meeting held where experience exchange and capacity building took place. At the DC level, Project management sub committee members are sharing responsibilities and CEHP supported staff members are also involved occasionally in other services of the DCs. HIV mainstreaming: HIV prevention related activities were incorporated eye care and PHC. During the cataract surgical eye camps, IEC materials about primary eye care, HIV & AIDS, primary health care were also displayed at the sites where patients and their escort had to wait sometime for the service. Whenever it was possible health education was delivered by volunteers using education posters. Information stalls on HIV are set up during each camp and patients and family members get IEC materials from there. CFs have been trained on HIV prevention, eye and ear care to link the project components of the CEHP to the community. The community groups determined action members and action groups who share community people about HIV and AIDS. Gender: CEHP has taken Gender as priority in all possible areas. During development of policy and manuals Gender sensitivity it maintained to the possible level. At the grassroots level, more focus has been given for women empowerment providing equal opportunity on leadership and also on obtaining services with focus on promotion of safer motherhood and water and sanitation related issued to reduce burden on women. CEHP has promoted trainers on Gender and also have carried out sensitization workshop to the staff members at CEHP. The vice coordinator at CEHP itself is the female among 7 members and plays important role on decision making. Yet, there is still low number of senior female staff. Each of the programme VDCs for Wat San and PHC has got a male a female facilitators, and each of the group consist of at least 50% female members. Most of the group leader and action members are female in the community groups. However, there is very poor ratio on gender balance as regard to the teacher trainers on HIV and AIDS programme. This is basically because of the stigma and low population of female teachers in the programme area. While developing peer educators at the schools, genders balance is always maintained. Gender is one of the main parameter in ICAP and has 14 indicator for assessment that helps to identify gender status of the DC. During ICAP almost all DCs have realised that they were weak on gender balance and have (30)

34 chapter planned actions to strengthen gender status in future. CEHP remains in continuous discussion with DCs to enhance understanding on Gender sensitivity and supporting DCs for women development related activities. Do no harm CEHP maintained the provision of the services for the poor and the vulnerable deprived section of community maintaining neutrality and involving all stakeholders equally and transparently. CEHP is constantly disseminating the importance of conflict management for peace and harmony, and has been successful to promote techniques of conflict management in the program area utilizing CEHP team members and the NRCS volunteers. CEHP encouraged all the CGs to carry out wellbeing ranking to understand actual community perception of each households in the villages. This has been successfully carried out by the CGs with the facilitation of CF. Some of the communities disagree on the subsidy provisions as per the wellbeing ranking. Though we had to remain firmed for its implementation as this provision addresses the need of the weaker families in the communities. There are 4 ranks and A is better off and D is the weakest with their economic status. Subsidy proportion from CEHP is higher to the D rank and there is no subsidy for the A. Human Resource Development In order to build the capacity in primary health care, a female expatriate, Mrs. Yoko Oda as health adviser has been deployed for one year to strengthen the health team in the areas of PHC, community facilitation, networking and the institutionalisation of HIV and AIDS. Finance: Mr. Amulya Vaish joined 2 days Advance Managerial Skill training/workshop in Kathmandu which was organized by Standard Icon P. Ltd.. He also visited Sustainable solution (supplier of accounting software) to get updated on upgraded version of the software (Money Work Gold).. Eye care: Mr. Badri Shrestha participated in the Vision 2020 workshop at Katmandu organized by Ministry of health, NNJS and Tilganga Eye Center. The objective of the workshop was review the eye care activities and make a strategy, do planning and give recommendation to the Ministry of Health for service improvement. Mr. Badri made a presentation about the service of CEHP. Mr. Ram K.C. participated in a meeting on Trachoma survey methodology and cluster sampling at National Trachoma Programme. Mr. Badri Shrestha from CEHP, Mr. Keshav Gautam and Mr. Dev Gautam (Secretary of NRCS DCs Bardia and Surkhet) participated in the "Global Consultation on Sustainability in Eye Care" workshop in October 2008 at Aravind Eye Hospital, Pondichery, India. On the way back, they visited various optical markets in Delhi and Lucknow to obtain information on verities of optical materials for CECC's shop. This visit further enhanced the confidence level of both CECCs to achieve self reliance on its operation. Bardia CECC even decided to review the staffing pattern and both the CECCs also explored reliable and cheaper supplier for optical and pharmacy related items to gain higher profits. Three OAs Mr. Prakash Shahi, Mr. Pradeep Jung Shah and Ms. Purnimaya Gurung were trained in Primary Ear Care. Mr. Chhandu Lal Tharu, In charge of CECC Bardia has joined one month long Refraction training at Himalaya Eye Hospital, Pokhara. The training was supported by CEHP to enhance his skills to be further support on optical service management to generate income. Mr. Ghan Bahadur Thapa, CECE In charge of Surkhet participated in low vision refresher training at Himalaya Eye Hospital Pokhara. HIV: Mr. Bharat Rijal attended a regional meeting organized by Youth Action Nepal in Nepalgunj. The meeting was focused on the issues of migrants. Mr. Kamal Baral and Mr. Bharat Rijal participated in 3rd National AIDS Conferences organized by National Centre for STDs and HIV and AIDS Control Board. Almost all organization working in the field of HIV & AIDS participated from all over the country. Mr. Bharat Rijal also participated in the National Expert Seminar on Reproductive Health organised jointly by the Family Health Department, the Population Division, and the Family Planning Association Nepal on 7 8 September in Kathmandu. The purpose of the seminar was to carry out a stock taking of the lessons learned with different (31)

35 youth friendly approaches to promote sexual and reproductive health and to prevent HIV among young people in Nepal. Furthermore the participants drafted an advocacy strategy to promote Sexual Reproductive Health Response (SRHR) for young people with a view to informing future policy and action in the future programming of the National Health Strategic Plan II (NHSP II) Mr. Shankar Bhattarai participated in the orientation meeting on Geographical Information System mapping for condom promotion organised by Mitra Samaj (a NGO working in the promotion of Condom) in Nepalgunj. The objective of the meeting is to encourage the availability of condom and use of condom among the Most At Risk Population (MARP). OD: Mr. Hari Subedi participated in a 12 days TOT on Gender organized by Stri Shakti, Kathmandu, NGO at Dhulikhel, Kabhre. This was the last part of the series of courses of Master Trainer for Gender, he had been attending since last few years. One day gender sensitization orientation was organised as in house training for 14 CEHP staff members. It was facilitated by Mr. Hari Subedi. Mr. Prem Dixit also facilitated an in house orientation for the eye care team member on advancement of low vision management. Participation of the staff members and volunteers in the various training and workshops has enhanced their motivation level and professional performances such as facilitation, presentation, leadership skills, etc. Main results of self evaluation Further effort is needed to promote OD as a core part of the DCs development, so that the DCs implements OD activities as per plan. HQ also has focused in its Five Years Development Plan ( ) to establish a system to enhance the capacity of the district chapters. ICAP tool has been appreciated by all DCs including NRCS HQ and it needs to be promoted further. The development of the professional capacity among volunteers is a basic requirement in order to be compatible to other development agencies. OD needs to be associated or integrated as core part of the projects to develop interest among the DC's authorities. Promoting capacity building as a separate and isolated component seems less effective. Effective coordination and communication is necessary to avoid overlapping/duplication of resources collected at the DC level from various projects and other sources for capacity building to achieve better results. Problems, solutions and recommendations It remains a challenge for the OD unit to make the DCs realise that capacity building as one of the most important aspects of their institutional development. Since most volunteers from the chapter are nonprofessionals they consider input to infrastructure as main criteria for OD. CEHP will continue to change the thinking of the volunteers and to develop their professional skills. Banke, Mugu and Dolpa DCs still lack the baseline data of ICAP, and further attempts will be made to do it in all DCs in the region. Outlook for 2009 Conduct ICAP at Dolpa, Mugu and Banke district chapters. ICAP review workshop at Kalikot, Mugu, Salyan, Bardia, Dailekh, Surkhet, Dang, Humla, Salyan, Jajarkot, Rukum and Rolpa chapters; Resource mobilization training at 4 district chapters; Coordination with NRCS HQs to develop a common tool for capacity assessment; support to DCs to carryout 10 conflict management workshops. Continuous input to DCs on various aspects of OD to develop them as well functioning chapter of NRCS. (32)

36 Risk Assessment The security situation of the country is still poor. General strikes, blockades and other agitating activities are directly affecting the CEHP services. CEHP maintained the provision of the services for the poor and the vulnerable deprived section of community maintaining neutrality and involving all stakeholders equally and transparently.. CEHP is constantly disseminating the importance of conflict management for peace and harmony, and has been successful to promote techniques of conflict management in the program area utilizing CEHP team members and the NRCS volunteers. Uncoordinated fund flow in the program area through many NGOs has posed a challenge to the self help promotion principle. People are more interested to receive hardware facilities. In this context, it is still challenging to interest DCs in the software approach for self help.. Some communities disagree on the subsidy provisions as per the wellbeing ranking. Though we had to remain firmed for its implementation as this provision addresses the need of the weaker families in the communities. It is till challenging to make DCs understand professional and participatory approach on programme/project management. Most of the time classical management approach and internal politics creates significant interference to achieve results. Over the last year a lot of efforts were made to create new partnerships. Successful partnerships have been created with District Development Committee Pyuthan, Wat san Division office Pyuthan, District Education Office Pyuthan, DHO of project districts, Community Forest User Committee of Bardia, Lions Club of Nepalgunj, UNDP, FPN Nepal CRS, Pyuthan Plus, National Trachoma Programme, CARE, NFHP, ADRA, etc. Visitors Mrs. Margrit Schenker, Head of Europe & Asia and Mrs. Monika Christofori Khadka, Programme Coordinator, Swiss Red Cross HQs visited Nepal and to monitor the projects supported by Swiss Red Cross. They visited Jumla and Surkhet and observed services at micro level. They discussed with DC, Sub chapters, community groups, volunteers and staff members to understand the implementation modality of the projects and its benefit to the people in need. They also provided feedbacks to increase the effectiveness of the programme. In Jumla, Mrs. Margrit Schenker inaugurated Hiyakhola Gravity Flow water scheme of Lamra VDC. Following their feedback Programme Director carried out in depth discussions with all units on the feedback and have started to implement by each units. A fund raising film team from SRC HQs visited to CEHP projects in the month of June and September, and made still and movie being in the programme VDCs in the hills and in Terai. Finance The total expenditures of the CEHP during April December, 2008 were NPR 20,944, Internal audit and physical verification of this project for the period Jan 2007 to March 2008 has been carried out by NRCS HQs. At the same time External audit of CEHP was also carried out by AJJ & Associate, Kathmandu. NRCS HQ also deputed Mr. B. B. Lamichhane, an auditor to carry out statutory audit of the CEHP for the period from July 2007 to June The auditors appreciated the over all management system of CEHP. Conclusion The year 2008 was another successful period for the CEHP. The changed political situation has generated a favourable environment for the project and its staff members and volunteers are able to work in a much safer situation. The programme met most of the target on all components though cataract surgery service at Surkhet could not be started since the cooperation modality with partner institution is yet to be agreed; some of the training programme for the staff members could not be organised because of extensive activities; and Bardia CECC could not carry out refraction service because of conflict between staff and management. Construction of Rain Water Harvesting Jars in Pyuthan district was also delayed and the partnership with local body of the government could not be finalised in year 2008, and will be materialised (33)

37 The services from the CEHP are directly reaching the people in need. The inclusion of hardware services in the PHC after starting up the software services proved to be a good approach. This services have provided recognition to the DCs as sustainable development organisations as most of the time Red Cross are know only as relief organisation. Sustainability of project components (e.g. the management of the CECCs and the institutionalisation of HIV in the DCs and schools) still remains a challenge and requires further motivation and input. CEHP s firmness in proceeding with the handing over made DCs realise their potentials and skills. The handing over also requires a flexibility from the CEHPs side to accept the modes of continuation as set by the DCs. In how far this involves a compromise in quality service provision still needs to be seen. DCs ability to manage projects on their own was boosted through the award of other donor projects such as from Global Fund, UNDP, etc. There has been strong demand from the DCs that additional to working with schools, there is a need to work with the community people as the HIV is becoming more and more prevalent in housewives of the rural communities because of various risk factors. The program over all was successful to provide extensive services in need and was a help to initiate improvement on institutional capacity of DCs of programme districts. The overall services of the CEHP and its projects have further promoted positive image of the Red Cross in the region area. Many thanks to Swiss Red Cross, the back donors and everyone contributed to make this year very successful to serve people in need. Contact for further information: Nepal Red Cross Society Community Eye Care and Health Promotion Program (CEHP) P.O. Box: 7, Near District Post Office Sadarline Road, Nepalgunj NEPAL Telephone: , Fax: info@nrcscehp.org, cehp@nrcscehp.org Webpage: (34)

38 Annex 1: List of abbreviations ADRA Adventist Development and Relief MoU Memorandum of Understanding Agency ANC Antenatal Care NCASC National Centre for AIDS and STI Control AM Action Member NHSP II National Health Strategic Plan Two AG Action Group NSAARC National STD & AIDS Research Centre BCC Behaviour Change Communication NNJS Nepal Netra Jyoti Sangh CA Constitutional Assembly NRCS/RC Nepal Red Cross Society/ Red Cross CBO Community Based Organization NTP National Trachoma Programme CECC Community Eye Care Centre OA Ophthalmic Assistant CEHP Community Eye Care and Health Promotion Programme CF Community Facilitator OAS Ophthalmic Assistant Supervisor CG Community Group OD Organizational Development CSR Cataract Surgical Rate OPD Out Patients Department DC District Chapter ORS Oral Rehydration Solution DDC District Development Committee PEC Primary Eye Care DEO District Education Office PEs Peer Educators DPHO District Public Health Office PHC Primary Health Care ECV Eye Care Volunteer PLWHA People Living With HIV and AIDS FBEH Fateh Bal Eye Hospital FC Field Coordinator FCHV Female Community Health Volunteers PRA Participatory Rural Appraisal FECH Foundation Eye Care Himalaya RAAB Rapid Assessment of Avoidable Blindness GFWS Gravity Flow Water System SAFE Surgery Antibiotic Face washing Environmental improvement GTZ German Technical Cooperation SG Support Group HHs Households SRC Swiss Red Cross HP Health Post STI Sexually Transmitted Infection HRD Human Resource Development TEC Tilganga Eye Centre HQ Head Quarter TF Trachoma Follicles ICAP Institutional Capacity Analysis Process ToT Training of Trainers' IEC Information, Education and TS Teacher Sponsor Communication IFRC International Federation of Red Cross TT Trachoma Trichiasis and Red Crescent IOL Intra ocular Lens VCT Volunteer Counselling and Testing J/YRC Junior/Youth Red Cross Circle VDC Village Development Committee KAP Knowledge, Attitude and Practice VHW Village Health Worker MARP Most At Risk Population Wat San Water and Sanitation M & E Monitoring and Evaluation WSSDO Water Supply and Sanitation Division Office MoH Ministry of Health (35)

39 Annex 2: Volunteers and staffs at CEHP (at the last quarter of the year 2008) Steering Committee of CEHP Name Position Name Position Mr. Lalit Jung Shahi Convener Ms. Narbada Sharma Vice-Convener Mr. Ajeet Kumar Sharma Member Mr. Sanat Karki Member Medical Director, FBEH Member Director, Health Dept, NRCSHQ Member Mr. Kamal Baral Member Secretary Staff members, Nepalgunj Base Mr. Kamal Baral Program Director Community Eye Care OD/PHC & Water/Sanitation Mr. Badri Prasad Shrestha Sn. Program Officer Mr. Hari Prasad Subedi Mr. Raj Kumar Kshetri Sn. Program Officer Sn. Field Coordinator Mr. Ram KC Ophthalmic Officer Mr. Resham Bahadur Khadka Field Coordinator Mr. Prem Kumar Dixit OA Supervisor Mr. Ramesh Prasad Bajgail Technical Coordinator/Overseer Mr. Sher Bahadur Chand Ophthalmic Assistant Mr. Dhan Bahadur Shahi Sub-engineer Mr. Purnimaya Gurung Ophthalmic Assistant Mr. Rupa Pandey (Bardia) Field Coordinator Mr. Nim Bahadur Dangi Ophthalmic Assistant Mr. Binod Sharma (Salyan) Field Coordinator Mrs. Buddhimati Tharu Motivator Mr. Dharm Raj Shahi (Pyuthan) Field Coordinator Mr. Kali Bahadur Dangi Motivator Mr. Hari Gopal Chaulagai (Jumla) Field Coordinator Finance/Administration Organizational Development (OD) Mr. Amulya Vaish Sn. Finance/Admin Officer Mr. Pradeep Gautam Sn. Field Coordinator Ms. Kiran Kunwar Secretary Mrs. Asha Shahi Store In-charge HIV/AIDS Prevention Mr. Kanhaiya Lal Bajpai Finance/Admin Assist. Mr. Bharat Rijal Sn. Field Coordinator Mr. Mani Ram Tharu Driver/Logistic support Mr. Shankar Prasad Bhattarai Field Coordinator Mr. Prem Bahadur Bohara Messenger Mr. Bijay Thapa Magar Messenger CECC, Dailekh Mr. Tilak Bahadur Bohara Guard Mr. Prakash Chandra Shahi OA Supervisor Mr. Yam Lal Pandey Messenger CECC, Bardia CECC, Jajarkot Mr. Chhandu Lal Tharu Ophthalmic Officer Mr. Pradeep Jung Shah OA Supervisor Mr. Hari KC Ophthalmic Assistant Mr. Tek Bahadur Karki Messenger Mr. Babu Ram Regmi Messenger CECC, Surkhet Mr. Ghan Bahadur Thapa Mr. Bijay Shrestha Mr. Ram Prasad Acharya Ophthalmic Officer Ophthalmic Assistant Messenger Total staff members: 38 (CEHP, CECC and district chapters) (36)

40 Annex 3: Cumulative HIV and AIDS Situation of Nepal Ministry of Health and Population National Centre for AIDS and STD Control Cumulative HIV and AIDS Situation of Nepal As of Mansir 2065 (15 December, 2008) Condition Male Female Total New Cases in This Month HIV Positives (Including AIDS) AIDS (Out of total HIV) * 48 Cumulative HIV infection by sub-group and sex Sub-groups Male Female Total New Cases in This Month Sex Workers (SW) Clients of SWs/STD Housewives Blood or Organ recipients Injecting Drug Use ** 21 Men having Sex with Men (MSM) Children Sub-group NOT identified Total ** Mode of Transmission IDUs or Sexual Cumulative HIV infection by age group and sex Age group (Years) Male Female Total New Cases in This Month above Total * Cumulative death: 509 New death case in Mansir 2065 (15 December, 2008): 3 (37)