Patients waiting for consultations at one of the RMF-supported MCH clinics in Palpa
October – December 2017
The clinic has established itself as an accessible, reliable service provider in terms of maternal and child health in Palpa and surrounding areas. The clinic charges a nominal registration fee, and all basic services, such as check-ups, immunizations, and counseling are free.
The town and satellite MCH clinics are fully dedicated to providing antenatal and postnatal services, as well as growth monitoring of children under 5 years of age and treatment of their ailments according to community-based integrated management of neonatal and childhood illnesses (CB-IMNCI) protocol. The clinic also provides:
- Immunization services for infants as per the National Immunization Program (NIP).
- Short-term and long-term contraceptives
- Counseling on the prevention of mother to child transmission of HIV/AIDS (PMTCT)
A child being vaccinated according to the NIP schedule in one of the MCH clinics
Health Services for Children Under 5
1,302 Children Visited the Clinic
In the fourth quarter, October–December 2017, a large number of under-5 children were seen at the MCH clinics. Among the 1,302 children visiting the clinic, 185 were new patients, while 1,117 had come for a follow-up visit. 1,120 children were healthy and required services like growth monitoring and immunization.
As the staff provides teaching sessions and personal counseling to each client, the overall nutritional status of the children was very good. 1,280 (98.3%) of the children were found to have a well-maintained nutritional status.
Nepal’s National Immunization Program (NIP) requires a child to attend 7 immunization appointments against 11 diseases during infancy. The children who are brought to the MCH clinics return until the immunization cycle is completed. The immunization coverage at the clinics is more than 90%. This is a significant achievement in terms of immunization coverage for an MCH clinic in Nepal, indicating the efficiency of the health services.
Monthly meeting with Female Community Health Volunteers (FCHVs) at the MCH satellite clinic in Darlamdanda
Maternal and Reproductive Health Services
Antenatal Care and Contraceptive Measures Provided
The MCH clinics have gained the goodwill of surrounding communities by providing accessible, effective maternal and child health services. ANC visits provided to a total of 817 clients. 241 were newly registered cases, while 576 came for a follow-up visit. The clinics also provide DT (diphtheria and tetanus) vaccines to pregnant women twice during their period of pregnancy. This injection is an initiative of the Nepal government to reduce neonatal mortality due to neonatal tetanus.
In Nepal, contraceptive measures are highly accepted by married couples, and the Nepal government governs contraceptive methods via a family planning program. At the MCH clinics, temporary contraceptive services are provided, including oral contraceptive pills (OCP), depot medroxyprogesterone acetate (DMPA/Depo-Provera), progesterone implants, intrauterine contraceptive devices (IUCDs), and condoms. The staff is trained for invasive contraceptive procedures like implants and IUCDs. They also provide ample counseling so that women are well aware of the benefits and possible adverse effects of respective birth control methods.
Counseling and Health Education
Vital Services Provided
In addition to antenatal, postnatal, child health, and family planning services, the MCH clinics also provide counseling regarding the prevention of mother to child transmission of HIV (PMTCT) to HIV-positive and vulnerable families. This service is regarded one of the most vital of the MCH clinics, as it has been able to generate interest and address such a critical issue at the community level.
To render the health services complete, proper health education is also provided to all patients. The clinics regularly hold teaching sessions for patients regarding diverse, relevant health issues. Those regularly attending the health education sessions and are highly benefitted. This is reflected in the high number of patients seeking immunization and other preventive health services.
RMF Senior Registered Nurse examining Sabita during an ANC visit
Sabita, Age 28
Sabita is a 28-year-old woman who is a resident of Tinau Rural Municipality-6 in Palpa District. Married for nearly 10 years, she has one son, and her husband is employed abroad. Sabita is now pregnant for the second time. She is a very conscientious woman and has attended her eighth antenatal visit at the MCH clinic. Her pregnancy is normal to date: the size of the uterus matches the period of gestation, she has normal blood pressure and no swelling in her legs, and the fetus has a regular heartbeat within the normal limits. Sabita has been warned about the danger signs during pregnancy and is ready to visit the hospital immediately if any of these should occur.
Sabita visited the MCH clinic regularly during her last pregnancy as well. She is very satisfied with the services that the clinic provides, and for that reason, she attends the clinic on each prescribed date and participates in the health education sessions too. Sabita states that she has advised her neighbors to visit the clinic for quality services and full satisfaction, adding that in a time when medical services have become a business, she has received services of excellent quality at the lowest cost possible. Not only she has been counseled about care and rest during pregnancy, but also about early preparation of postnatal supplies, such as diapers and baby carriers, arranging transportation once she is in labor, warning signs, and more. Furthermore, Sabita has learned that including a family member, especially her husband, during the counseling will make the family member feel more responsible and help them take better care of her.