Nepal integrates hygiene promotion with routine immunization

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Mamata Bharati is a community health worker from Khopasi, Nepal. While raising awareness of childhood immunization has been her role for years, it has now expanded to include educating mothers on the importance of sanitation and nutrition.

“I advised mothers to take their children to health centers to be vaccinated five times in the first nine months after birth. Thanks to the knowledge I acquired during the training at the Khopasi health center, I am now in charge of informing them about sanitation and nutrition as well,” explains Bharati. “It helped to improve the health of the child as well as that of the family.”

Bharati believes that the awareness campaign on sanitation coupled with routine vaccination helped control the pandemic.

“Masks, physical distancing and disinfectants are the main preventive measures against COVID-19 infection. They should be given priority, along with vaccination.

“The importance of sanitation, masks and sanitizer was highlighted at the start of the COVID-19 pandemic in January 2020. Good hygiene practices have a crucial role in the fight against communicable diseases like COVID-19,” she added.

Mamata Bharati, a community health worker from Panauti-10 township, Khopasi, Kavre district in Nepal.
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Bharati believes that her efforts have proven successful. She attributes the relatively weaker effect of the second wave of the COVID-19 pandemic in Khopasi village to the promotion of sanitation and other hygiene practices.

Devaki Khadka, a female community health worker from Tikhatal, also briefed residents on sanitation and nutrition.

“Before programs targeting sanitation, diarrhea claimed the lives of many children. An awareness campaign dedicated to sanitation made a difference,” she shares. “I go door to door to talk about sanitation, vaccination and health. I advise people to wash their hands before eating. I also teach them how to keep their bodies clean.

Khadka also believes that the sanitation awareness campaign has been instrumental in tackling the COVID-19 pandemic.

“I motivate pregnant women to eat green vegetables, yellow fruits, beans, fish, meat and other foods with high nutritional value in their meals,” she adds.

This expansion of the role of female community health workers (ASCF) follows a major shift in health policy in Nepal. The Ministry of Health and Population (MoHP) of the Government of Nepal has initiated the “Hygiene Promotion through Immunization” program at the local level through health centers.

According to the Child Health and Immunization Section of the Family Welfare Division of the Ministry of Health and Health, the ministry worked with organizations like Wateraid and USAID to make the program work. . The Ministry of Health and Health decided to add “integrated hygiene promotion” to the routine immunization program in December 2018, but implementation only started in July 2020.

2,700 health workers across the country were mobilized and MoHP officials saw the results. “The integration of hygiene promotion into the routine immunization program has proven successful so far. The program has set itself the goal of mobilizing female health workers across the country to educate mothers on sanitation and nutrition,” said Dr. Samir Kumar Adhikari, MoHP Joint Spokesperson.

Dr. Achyut Raj Karki, COVID-19 focal point at Bir Hospital, Nepal’s oldest government hospital, hails the government’s two-pronged strategy for disease prevention and control.

Dr Achyut Raj Karki, Covid focal point at Bir Hospital, Nepal's oldest government hospital.
Dr Achyut Raj Karki, Covid focal point at Bir Hospital, Nepal’s oldest government hospital.
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“I think the government placing a high priority on promoting good hygiene practices such as washing hands with soap and using a mask and sanitizer during the COVID-19 pandemic has contributed to its success in the fight against against the pandemic,” said Dr Karki. “This makes sense because the majority of infections occur through the hands. Regular contact of the hands with the eyes, nose and mouth causes the virus to be transmitted to the body.”

Emphasizing that the pandemic cannot yet be considered over, he added, “Masks, physical distancing and disinfectants are the main preventive measures against COVID-19 infection. They should be given priority, along with vaccination.

The federal government’s decision was greatly facilitated by the coordination of local governments. Balaram Tripathi, head of Kathmandu Metropolitan City’s health department, says the city has integrated its Water, Sanitation and Hygiene (WASH) program into the routine immunization schedule.

Balaram Tripathi, Head of Kathmandu Metropolitan City Health Department, Nepal.
Balaram Tripathi, Head of Kathmandu Metropolitan City Health Department, Nepal.
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“The multi-level focus on hygiene has motivated community members to improve their sanitation behavior. It also helped to deal with the pandemic,” he explains.

MoHP reports indicate that Nepal’s case fatality rate (CFR) is 1.2% so far. This is less than four of the eight SAARC countries. Bhutan, Maldives and India have a lower CFR than Nepal, while Afghanistan, Sri Lanka, Bangladesh and Pakistan have a worse CFR.

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