This page provides an overview of the initial community needs and assets assessments that Nyaya has undertaken as we have planned our health services and interventions.  

Nyaya's Rapid Health Assessment

This was our preliminary health assessment of the region which provided the general epidemiological picture for our overall clinical and public health approach:

http://nyayahealth.pbwiki.com/f/HA_Achham.pdf

Nyaya's Health Economics Survey

This was our subsequent health economics survey which provided some insight into our evolving system of health finance for our clinical operations:

http://nyayahealth.pbwiki.com/f/Health%20Economics%20Survey.pdf

We will be posting the results of our community health worker surveys shortly.

Institutions and Infrastructure in Rural Nepal

The following lists provide a summary of some of the government and community institutions that we have interfaced in the course of our work.

Information on existing regional institutions

• Mothers/ Farmers groups in the local communities - do they exist? are they equally representative of elites and marginalized communities (or are they run by local politicians and high-caste persons only)?
• District Health Office (DHO) / Ministry of Health and Population (MOHP) - do they have a regional office? are they functional? what services do they offer?
• Health posts / Sub-health posts - do they exist? do they function? what services do they offer, how reliably? who works there, and are they trained officially or is it a "quack doctor"?
• Hospitals - nearest hospitals? what services do they offer? is there a reliable transport route between the village and that hospital (i.e. for referral purposes)?
• Female Community Health Volunteers (FCHVs) - FCHVs are the government's community health workers. They are functional in some districts, non-functional in others. Figuring out what services are available and what community perception of FCHVs is will be helpful to plan community public health programs
• Traditional doctors - who are they? how popular are they, and for what conditions? how do they operate? are they willing to partner with government/NGO health institutions (i.e. "Western medicine")?
• Abortion services (legit or otherwise) - commonly known as "CAC" (Comprehensive Abortion Care) - does it exist? Is it safe? Community perceptions? Who are the practitioners?
• Airports - existence? services? reliability?
• Roads - do they exist? are they reliable? during monsoon season? are road traffic accidents a significant driver of m&m?
• Schools - primary, secondary, technical training schools (e.g. for midwives etc)?
• Information communications technology - cell phone reception? internet availability? regional telemedicine centers?
• Power supply - does the grid work? what is average load-shedding / day? are there generators/inverters available or will they have to be shipped from KTM?
• Water facilities - wells vs natural source? how far do women have to walk? taps? etc
• Sanitation facilities - what is available? local customs? 
• Other non-profit organizations - health, micro-finance, family planning, agriculture, etc - what is around, who is reliable, who is politically-affiliated, etc?
• Supply chain - is there a reliable transport mechanism to bring in supplies (e.g. meds, equipment)? does the DHO have a supply chain for vaccines/TB meds/ART etc (these are free from DHO to any health facility in Nepal)?

Social, cultural, economic customs

• Caste system - how prevalent/important in the community?
• Chhaupadi - does it exist in this area? how prevalent? what are community perceptions of its existence? of stopping it? (if you're not familiar with the practice see BMJ article cited here: http://blog.nyayahealth.org/2010/03/26/chhaupadi/)
• Migration to India for work? - In Achham ~60% of males migrate to India for work leading to a huge HIV burden and lack of male figures in the family unit...
• Economy - local work? drivers of the economy? occupational health hazards?
• Prioritization of males over females - selective abortion/infanticide? education of girls? opportunities generally for women?
• agriculture / food sustainability - what are food sources? farming practices? malnutrition prevalence?