Health for Life (H4L) project

USAID’s Health for Life project strengthens the Government of Nepal’s capacity to plan, manage, and deliver high-quality family planning and maternal, newborn and child health services.

In spite of its mountainous Himalayan terrain and high rates of poverty, Nepal has experienced two decades of steady improvement in health and emerged as one of the few countries to meet the Millennium Development Goals (MDGs) to reduce child and maternal mortality. For over 60 years, the U.S. Government has partnered with Nepal to strengthen the delivery of essential health services, especially for those in greatest need.

Program Overview

Health for Life (H4L) is a $27.9 million, five-year project working primarily with the Government of Nepal’s Ministry of Health and Population (MOHP) to support the testing and roll-out of national-level policies, guidelines, and programs. In addition to its national focus, the project works with other partners in 18 disadvantaged districts in the Mid-Western and Western regions. In these areas, it helps strengthen district and village health systems and help identify and implement best practices. H4L collaborates with a wide range of stakeholders, including academic and research institutions, training centers, media partners, and civil society. After the devastating earthquakes in April and May 2015, H4L began supporting the MOHP in 10 of the 14 most-affected districts to improve health system governance, improve evidence-based planning, budgeting and policy making, and to institutionalize nationwide system for quality assurance and improvement.

The primary goal of H4L is to strengthen the Government of Nepal’s capacity to plan, manage, and deliver high-quality and equitable family planning, maternal, newborn, and child health services. H4L activities directly address key health system constraints in the following areas: local health systems governance; data for decision making and evidence-based policy development; human resources management; quality improvement systems; and knowledge and behavior change.

PROGRAM OBJECTIVES

• Improve health system governance of district health offices and sub-district level facilities
• Develop and implement national evidence-based health policies
• Strengthen national-level stewardship of the health sector
• Institutionalize a nationwide system for health care quality improvement
• Improve the capacity of district and local level health workers and community volunteers to deliver high-quality family planning and maternal and child health and nutrition services
• Improve the knowledge, behavior and use of health services among target populations
• Strengthen the capacity of USAID’s contractor, LifeLine Nepal, to improve Nepal’s health logistics system

PROGRAM ACTIVITIES

• Strengthen Health Facility Operations and Management Committees (HFOMCs) by supporting their regular meeting, ensuring the inclusion of disadvantaged groups in their composition, that they are following the established guidelines for HFOMCs, and are informing service delivery decisions that improve community health.
• Train local government officials to better manage health care services for all, especially marginalized and disadvantaged persons, and to incorporate community and client feedback from HFOMCs, social audits and public hearings
• Establish and strengthen mechanisms for timely, evidence-based decision making to respond effectively to local health need.
• Test and scale up a health service quality improvement system suitable for Nepal.
• Improve quality pre-service training for Auxiliary Nurse Midwives and enhance clinical skills of lower-level health workers.
• H4L will train IEC/BCC program planners and implementers at the central (as well as regional, district and community) level to develop IEC/BCC interventions and activities to effectively reach M/DAGs, and adolescent and youth populations.

KEY RESULTS

H4L will support the Government of Nepal (GoN) to achieve the following results:

• The GoN approves a collaborative framework and implementation guidelines for local health governance, decentralizing planning and budgeting, and meeting the needs of communities
• Implementation of the Collaborative Framework in six districts (Dang, Jumla, Kaski, Chitwan, Jhapa and Kailali), laying a foundation for nation-wide scale up
• The HFOMCs effectively manage facilities, helping improve access to and use of health services and improved quality of care
• District and regional MOHP review meetings effectively use data to identify and monitor actions to improve performance
• The National Health Research Council leads a collaborative process with academics, practitioners and donors to prioritize studies for a national research agenda
• Facility-based quality improvement system is institutionalized nationwide
• Pre-service training and teaching methods for Auxiliary Nurse Midwives strengthened
• Use of maternal, newborn, child health and family planning services is increased among adolescents, and marginalized and disadvantaged groups.
• Gender-based violence and early marriage are reduced