Interview by Savina Xavier
Nepal’s rapid development is proof of initiatives at the grass-root level. NGOs at Nepal are drivers of such change, their constant efforts have fueled progress in uplifting the marginalized and poorest of poor in the country.
Back to Life (Back-to-life.org), Nepal is one such organization that has been working to improve health care, infrastructure, education, skill sets and human resource (HR) engagement in the provisions of such services.
It has been successful in engaging key stakeholders in delivering its services and has made considerable progress in reducing maternal, neonatal and infant mortality rates.
Talking about the future of Nepal, it says that the country has a lot of scope and that it is on the right track in terms of development.
It identifies the youth of Nepal as instrumental in the process of taking Nepal to greater heights. The organization believes that Nepali youth have very useful skill sets that can be tapped by the Nepal Government through creation of inbound opportunities.
Nepali Sansar finds it pleasure in interacting with ‘Back-to-Life’, which shares its experiences of working in Nepal and being part of the country’s development. Here are some excerpts from the interview:
1. NSB: Nepal has seen a drastic decline in maternal, neonatal and infant mortality rates, over the years. How significant has ‘Back to Life’ been in this process?
Dikendra Dhakal: Yes, you are right. The Maternal Mortality Rate (MMR) in Nepal decreased from 539 maternal deaths per 100,000 live births to 239 maternal deaths per 100,000 live births between 1996 and 2016. In 2016, roughly 12% of deaths among women of reproductive age were classified as maternal deaths. Also, after nearly a decade of stagnation, the Neonatal Mortality Rate (NMR) has decreased from 33 per 1,000 live births to 21 – a decline of more than one-third from 201 . Similarly, the Infant Mortality Rate (IMR) also declined from 46 in 2011 to 32 in 2016. While neonatal mortality still comprises more than half (54 percent) of under-five deaths, its share has certainly declined from 2011 when it was 61 percent.
Nepal is committed to the Sustainable Development Goals (SDG). Its targets for reducing MMR, NMR and IMR are very ambitious. For instance, Nepal seeks to reduce MMR to less than 70 per 100,000 live births by 2030. In order to achieve these important targets, the government, communities, NGOs and the private sector, all have to contribute.
As an organisation working mainly in the sectors of health, education and livelihoods, we are doing everything within our power to contribute to the well-being of women and children. In fact, contribution to reduced rates of mortality amongst mothers and new-borns continues to be one of our main goals. To achieve this, we have established Birth Centres in Mugu, one of the most remote districts of Nepal. Here, the ritual of Chhaupadi, which isolates women and girls during menstruation and child birth, continues to be widely-practiced and the district has some of the poorest health statistics in the country, together with a very weak public health structure.
The first ‘Back to Life’ Birth Centre opened in 2011. By now, we operate seven Birth Centres in different villages in the district. These facilities are able to cover around one third of the households in Mugu. Right now, we are in the process of establishing another six centres. Hence, by the end of 2019, we will be able to reach more than 70 percent of the local population.
The Birth Centres provide quality service in the areas of maternal, new-born and child health. We are extremely happy to learn that the impact of our work shows in the health reports for the district. Since 2015, Mugu’s District Health Office has not recorded any maternal death. Similarly, the record shows that there were only three neonatal deaths in 2011. In 2018, there is not even one so far. This is fantastic! The infant mortality has also decreased in the same manner. In 2013 and 2014 there were six and five deaths respectively.
The medical staff at our Birth Centres is well qualified. They are trained midwives and medical assistants, who do not only supervise the deliveries, but also provide professional antenatal and postnatal care to mothers and children. They also run important awareness activities for the whole community, joining hands with the community health volunteers and health post staff, where available. The families are counselled on basic health care, including the critical topics of nutrition, hygiene, and family planning. Hence, we have been contributing to a variety of SDG targets, including percentage of women having antenatal and postnatal care visits as per protocol, institutional delivery, contraceptive prevalence rate, and health worker density and distribution.
2. NSB: Considering the fact that children are the nation’s future citizens, what according to you are the obstacles that these little ones face in access to quality education in Nepal’s case?
Dikendra Dhakal: Of course, the children of any society in the world are very important as they are the pillars of the nation. In Nepal, 42% of the total population is under 18 years of age. Unfortunately, the education sector in rural parts of our country is a big issue.
It starts with the school infrastructure. Many schools don’t have proper classrooms available. Sadly, the 2015 earthquake has made the situation even worse. The classrooms are so small and congested. Many schools lack basic furniture such as desks and benches. Also, the early childhood and development centres are poorly equipped.
Teaching quality is another major impediment. Many schools don’t have an adequate number of teachers, and very often teachers lack training and teaching skills. Furthermore, access can be constrained by the costs for school uniforms, which are mandatory in Nepal, and other supplies children need for school. If you go into a school, poverty becomes very visible. Many children are sick or malnourished. These problems result in low learning progress and school drop-outs. Only 7 out of 10 children enrolled in first grade will reach fifth grade, and more than half of them drop out of school before reaching eighth grade. As per the 2011 Census, 14.3 percent of children between 5 and 12 years are out of school. This amounts to almost 800,000 children within this age group.
Against this background, we decided that upgrading school infrastructure would come first for our organization. So, we started the construction of school buildings in schools that had dilapidated and overcrowded facilities. We wanted to improve the learning environment for both the children and teachers. So far, we have built a total of 27 school blocks with 84 classrooms. All of them are fully furnished with whiteboards, desks, and benches. In addition, we have furnished more than 30 early childhood development centres.
To address the issue of quality, we have been providing in-service training to teachers. The trainings focus on making classroom activities engaging, participatory, and child-focused. We also provide teaching, learning, and reading materials. Now, the schools we work with all have a small library. We even provide school meals to create an additional incentive for poor families to send their kids to school every day. Finally, through a school sponsorship programme, we have given additional support and encouragement to children of very poor families. With the clothing, bags, and stationary they receive they no longer have to feel humiliated at school ¬– they are just like everybody else. Under this scholarship initiative, we provide direct support to more than 2,300 children in Mugu, more than 500 children in Chitwan and more than 200 children in Nuwakot.
3. NSB: It is heartening to see that you work on school reconstruction projects for Nepal’s little citizens. How about the public and the governmental support for such initiatives in Nepal?
Dikendra Dhakal: The public is very cooperative in school reconstruction. Every project should be participatory in nature and the public should contribute its part. However, poor families have little financial resources to contribute. In that case, we seek contributions in terms of labor, also considering their time as daily labor is very limited. During the phase of reconstruction, people were already badly harmed by the earthquake. They have lost their homes and most of their possessions. Though, even under such circumstances, we’ve seen our communities participate wholeheartedly in the school reconstruction process.
When it comes to NGO work, you often hear that the government is not supportive enough, is too bureaucratic, takes a very long time to issue permissions or provide responses. Yet, my impression is that the government, with its limited resources of man, material and money, is doing the best it can and I don’t see any reason to complain. Governments cannot give a blanket approval to foreign agencies; so, I do appreciate that they have to scrutinize NGO activities. However, I do hope that our government would do things a bit faster indeed. For example, the earthquake happened in April 2015 and it took a whole year for the government to endorse the reconstruction guidelines, which finally came into effect April 2016.
4. NSB: Back to Life has been actively conducting hygiene and sanitation awareness programs all across. How do you measure the success rate of such programs and public participation in Nepal?
Dikendra Dhakal: That is correct. Back to Life’s health projects also focus on improving hygiene and sanitation in schools and villages we work with. Those measures are often low-cost activities, yet highly effective in improving the public health. Our approach is two-fold, consisting of awareness activities with children and adults as well as small infrastructure development. For example, in Mugu, in addition to hygiene awareness, we focused on building toilets. When we started working in Mugu, less than 10% of people were using toilets. Open defecation is a root cause of many diseases, such as diarrhoea, cholera, dysentery, and typhoid. In 2009, cholera claimed the 300 human lives in the western part of Nepal. In addition, open defecation also prompts various protection concerns, especially for women and girls.
Our project staff conducted awareness activities to teach the villagers how to use the toilet and maintain adequate hygiene behaviors.
5. NSB: Despite making major strides in its health sector, certain areas like Mugu in Nepal still lack proper infrastructure and man power. As an organization addressing such issues, what measures do you think can bring a change in such areas?
Dikendra Dhakal: Yes, infrastructure and qualified manpower are very important. To address these needs, we have been building school buildings and Birth Centres. With the support of our sponsors we have been able to make a significant difference to Mugu’s health and education infrastructure as well as reconstruction after the earthquake in Chitwan, Lalitpur, and Nuwakot.
Besides infrastructure, it is very important to develop the local human resources to man these facilities and provide quality services to the communities. In terms of capacity development, we have been supporting teachers with in-service training and have sponsored young people from Mugu to attain qualifications in the fields of medical care and agriculture. We are a small player in this field, yet we are committed to doing our part. Human resource development in Nepal certainly needs more effort for many years to come, but luckily the government as well as other organisations, large and small, are working together towards this goal.
Meanwhile, we are happy to share you that Mugu has been declared an open-defecation-free district. The incidence of waterborne diseases has reduced, which is proven by the figures of the District Health Office and our own observation during our annual health camps in Mugu.
6. NSB: Youth has an effective role in societal change. How successful has your organisation been in engaging Nepali youth in your health awareness initiatives across the country?
Dikendra Dhakal: We are a small organization, currently focusing on three districts in Nepal. Therefore, we do not have awareness campaigns with national reach, yet we try to harness the important role of youth in triggering social change, within the limits of our resources. Here are some examples of how we engage youth:
7. NSB: Back to Life has been looking after the poorest of poor and the socially-excluded communities. What impact do you think your programs have left in bringing a difference in their lives?
Dikendra Dhakal: We try to address the needs of socially-excluded groups primarily through our geographic targeting. When we started working in Nepal, our question was, “where are the most forgotten communities?” And this is where we went. Within these communities, we focus our interventions on the ones most in need – hence, the majority of our beneficiaries are women and children.
When talking about impact, we have to think of sustainable, long-term changes in people’s lives. Hence, it might be too early to assess the impact for some of our initiatives. However, we do see a lot of positive impact already due to our Birth Centres, support for school children, solar lights and energy-efficient stoves. We’ve seen maternal, infant and neonatal mortality as well as decline in number of water-borne diseases in Mugu, improved access to and quality of education services in Mugu, Chitwan and Nuwakot as well as increased economic activity and food security due to a variety livelihood programmes and a significant reduction in the use of wood fuel. We closely monitor our programmes and are in constant dialogue with the beneficiaries about the effectiveness of our interventions and suitability to their particular needs. In addition, our programmes are periodically evaluated by an independent delegation of the Social Welfare Council.
8. NSB: Back to Life encourages rural people to create their own farmer cooperatives and livestock setups. How successful have you been in providing them the right market opportunities?
Dikendra Dhakal: Yes, by now we have facilitated the establishment of eight formal cooperatives in Mugu. We are very happy that the process of formalization went well and they have been actively operating since.
In a remote location like Mugu, market opportunities are mostly focused on the local demand, in addition to local and some foreign travelers. Over time, this may change with increased road access. We have been training the cooperative members to be able to analyse their market opportunities and identify new opportunities as they emerge. Based on this training, we also assisted the development of business plans. Right now, the groups are in the phase of capital formation. I think they are very serious about seizing the opportunities they have identified. Their prospects seem very positive.
9. NSB: Still a stigma in most parts of Nepal, women are not treated equally with men. Brief us about your success stories that empowered Nepali women over a period.
Dikendra Dhakal: Promoting the rights of women is one of the areas of our work, I am personally most proud of. With the Birth Centres, we are able to ensure women’s right to proper health care during pregnancy and when giving birth. The idea for our first Birth Centre in Loharbada was sparked by the local women themselves. It is great to see women using their voice and agency to exercise their rights and find their needs met. We try to foster this spirit further by setting up Birth Centre committees, in which women play a leading role. Likewise, all our cooperatives have women in executive roles. In our scholarship programme, we prioritize girls to make sure their education and personal development are valued equally. A village water scheme supported by Back to Life was implemented under the leadership of a local women. We purposefully encourage women to lead and provide chances to exercise their leadership within our projects. Also, we’ve been conducting social advocacy at community level to end child marriage. You see, empowering women is an important cross-cutting theme in all our activities.
10. NSB: A wide range of humanitarian activity at hand calls for the availability of large funds. What role do the Government and related stakeholders play in this regard?
Dikendra Dhakal: It’s hard to deny that every agency has its limitations; be it a government or a non-governmental actor. Therefore, both should work together combining resources and avoiding overlap of respective programmes. Whilst the Government is the main actor responsible to provide essential services to the people of Nepal, I believe other stakeholders should come in to fill gaps in terms of finance and technical capacities.
11. NSB: What are your future organisational plans for the less-privileged sections of Nepal and what areas do you wish to cover?
Dikendra Dhakal: We will continue our focus of supporting maternal and child health, education, livelihood and environment. Our programs will continue to be a mixture of infrastructure and capacity development. Mugu is still at the bottom of most development indicators in Nepal. Therefore, we are still committed to the district. In the next couple of years, our aim is to cover the entire population of Mugu with quality birth facilities. Likewise, we will also continue working in Chitwan and Nuwakot as we don’t see our mission completed in these areas.
12. NSB: There are many NGOs working for different underprivileged sections of Nepal, how are you different from them?
Dikendra Dhakal:Dikendra Dhakal:Dikendra Dhakal: As NGOs in development, we actually have a lot more in common than what sets us apart. Of course, we all share a common cause of supporting the development of Nepal, guided by the Sustainable Development Goals (SDGs) and each of our own missions and statues. Luckily, in the NGO sector, we have a diverse set of technical capacity and geographic reach. In this way, we can complement one another and also learn from each other.
What ‘Back to Life’ contributes to the NGO landscape in Nepal is certainly its commitment to tasks and places that may be considered complex or hard to reach and our very close contact with beneficiaries and the local government – a traditional grass-roots approach, I would say. Moreover, as a small organisation we are also somewhat more agile. For instance, after the earthquakes in 2015, Back to Life was one of the first organisations who had relief items and medical teams on the ground. I believe, today, we’re also increasingly known for our flagship programme, the Birth Centres in Mugu.
13. NSB: What according to you can make Nepal a developed nation? What do you think are the key focus areas for the country?
Dikendra Dhakal: Despite tremendous improvements, Nepal still counts as a Least Developed Country. Yet, there are lots of opportunities. Nepali people are the most pleasant people I have ever met. Of course, being Nepali, I might be biased in that respect.
Nepal is a beautiful and pristine country, which has a lot to offer – especially in tourism, hospitality, and clean energy. Many parts of Nepal are still uncovered. Personally, I wished the government and private initiatives would focus more on expanding eco-tourism. It can give jobs to many Nepali people who live in rural areas. Also, we do need perspectives for our young people. We see more than 1,500 youth go abroad every day. Imagine what skills and ideas we are losing! They should get more opportunities at home to learn, work, and earn a living. Ultimately, I think education and opportunities for young people will bring further development to our country.
Message from the CEO of Back to Life – Nepal. As an impactful organisation working for Nepal, Nepali citizens will love to hear from you. Any message
Tara Stella Deetjen, CEO Back-to-Life: I have known Nepal for more than 20 years and also raised my own son here, who went to school in Kathmandu for a couple of years.
In all those years I have seen many changes, challenges, natural disasters, and a lot of obstacles. Nevertheless, I admire the unbroken spirit, humility, and endurance of the people whatever hardship they had to face. I love the country, the culture, and the Nepali people dearly – in my heart I feel Nepali: Yo man ta mero root cause ho!
Right now, I am especially hopeful for the people in this country. Just this month, I’ve been so pleased to see the Nepali Government further strengthening the national law against child marriage. These are steps in the right direction. I think Nepal is on a good path indeed and we are very blessed to be part of this process! In Nepal Back to Life works with a team that is entirely Nepali as I strongly believe it is you that can change your country for the benefit of all.
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