The Sub-Health Post

The level of development in our supported community is, overall, extremely low. The fact that none of the schools had latrines or even clean water prior to our arrival indicates a lack of awareness for any kind of hygiene. Kumbu has a so-called Sub-Health Post (SHP), which was rarely operational and of little significance to the public. On top of that, the building was destroyed several years ago, so the station temporarily had to be moved to another room.

The old Sub-Health Post
Medical Equipment

In 2001, a Nepalese social worker had conducted a survey among women, who stated that a better service in the health station and especially the possibility to give birth to their children in better hygienic conditions had the topmost priority for them. This was the beginning for many further considerations, which ultimately resulted in our supporting the community to rebuild the health station, however at a scale which - in the interest of the women - surpassed the normal standard for SHPs by far.

In women assemblies in the Wards, the Social Worker Anshu tries to find out their expectations and priorities

During preparations, there were some dissensions over various details, which slowed down the process. However, during a visit in 2004, we were able to discuss all major points with the different partners and come to a mutual agreement. Construction began end of 2004, and the new station was commissioned in November 2006. It was designed in such a way that apart from the four rooms required by the national standard, it held the following extras:

The finished health station with toilet, auxiliary water tank and waste incineration facility

Delivery room
Yashoda examining a pregnant woman

Since births are not included in the functions of a SHP, the state doesn´t provide skilled birth attendants as personnel.. So while the health station was under construction, we have provided the study for a nurse (Yashoda Basnet) who can also help in obstetrics. Her salary is paid by us in full. 

Despite our financial support, the station has remained part of the national health care system, so that the regular running costs (for standard personnel, minimum provision with medication) are paid by the state. We cover all the costs that exceed the basic standard expenses.

The excellent equipment of the SHP has led the District Health Officer in autumn 2009 to propose its upgrading to a birthing centre. As a consequence of this, the state pays 2,000 Rs for each birth that occurs in the station, of which 50% is intended as an incentive for the women to deliver their babies in a clean hygienic environment. The remaining 1,000 Rs can be used to purchase any missing medicine. In addition, each woman is provided from project funds with two sets of baby clothes, so the newborn doesn't have to be wrapped in rags, as it is often the case.

 Obviously, this upgrading implicates that two skilled birth attendants must be available to guarantee a 24-hour stand-by service at the station. Nurse Yashoda, who has been supported by us since 2004, had first undergone a study as a CMA (Community Medical Assistant), including a basic training in obstetrics. After working in the SHP almost 3 years, she had since October 2009 the necessary additional formation in Kathmandu, so that she is working now as a second specialist alongside the state-paid nurse. Since we were paying a replacement with the necessary qualification during Yashoda's absence, the earlier mentioned upgrading to a birthing centre could already be effective in early 2010. We are happy about this remarkable acknowledgement of our work, as such upgrading is very rare for Sub-Health Posts.

Furthermore, we have transformed the room which was used as a meeting room into an inpatient ward, so pregnant women can arrive at the station earlier before their delivery and stay there until the day after. A possible replacement for the meeting room might be foreseen in a community centre, in case the respective  planning should be realized..

The health committee that is in charge of the health post had further suggested an extension of the building, in which one of the nurses on duty could live, and where the relatives of the expectant mothers could stay and prepare meals for the patients. In the meantime the building is finished and the interior furnishing will be done in first half of 2014.

As the health post's supply of medication from the state is utterly insufficient, we have agreed to establish a revolving drug fund, which we have endowed with a basic amount of money. With this fund, the missing medication can be purchased and even be bought by the patients, should they be able to pay for them. Into the fund go also the gains of the station from the premium the state pays for each birth, as well as the - albeit low - medical fees paid by the patients.