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AnnualProgressReport

16July2016–15July2017

PHASENepalSinamangal-9,KathmanduPhoneNo.016203479Email:[email protected]:http//:phasenepal.org

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TABLEOFCONTENT: ABBREVIATIONSANDACRONYMS…………………………………………………………………………………………………………………………….41 CHAPTER1:PROGRAMMEEXTRACTANDMAJORHIGHLIGHTS............................................................................6

1.1 Introduction...................................................................................................................................................61.2 Healthprogramme........................................................................................................................................71.3 Livelihoodprogramme...................................................................................................................................71.4 EducationProgramme...................................................................................................................................81.5 EarthquakeReliefProjects.............................................................................................................................81.6 Stafftrainingandotheractivities..................................................................................................................81.7 Coordination,NetworkingandMonitoring...................................................................................................9

2. CHAPTER2:ORGANIZATIONALINFORMATION...................................................................................................102.1. Vision&Objective.......................................................................................................................................112.2. ProgrammeComponents.............................................................................................................................112.3. Approach&Strategy....................................................................................................................................122.4. ProjectInformation.....................................................................................................................................13

2.4.1. CommunityDevelopmentProgramme(CDP)......................................................................................132.4.2. EmergencyReliefProject.....................................................................................................................142.4.3. MapofProjectAreas...........................................................................................................................142.4.4. ProjectFundingPartners:....................................................................................................................15

2.5. StaffStructure:.............................................................................................................................................152.6. SourcesofInformation................................................................................................................................162.7. StructureofReport......................................................................................................................................16

3. CHAPTER3:COMMUNITYHEALTHPROJECT.......................................................................................................173.1. StaffInformation.........................................................................................................................................183.2. MaternalHealth...........................................................................................................................................183.3. ChildHealth.................................................................................................................................................193.4. FamilyPlanning............................................................................................................................................213.5. HealthAwarenessRaisingActivities............................................................................................................213.6. LocalCapacityBuilding................................................................................................................................233.7. Clinicalservices............................................................................................................................................243.8. Issues,Challenges,Recommendation..........................................................................................................253.9. SuccessStories.............................................................................................................................................26

4. CHAPTER4:LIVELIHOODPROGRAM...................................................................................................................274.1. StaffInformation.........................................................................................................................................274.2. SpecificProjects:..........................................................................................................................................28

4.2.1. IntegratedProgrammeforthehealthofwomenandchildreninFarWesternNepal(Bajura,Mugu)284.2.2. IntegratedProjectforEarthquakeRecovery(Gorkha)........................................................................294.2.3. LivelihoodRecoveryProjectSindhupalchok........................................................................................294.2.4. ReducingtheImpactofPovertyonMaternalandChildHealthbyImprovingFoodSecurityandAccesstoBasicHealthServicesfor18,000peopleintheKarnaliRegionofWesternNepal..............................32

4.3. Challenges....................................................................................................................................................334.4. SuccessStories.............................................................................................................................................33

5. CHAPTER5:COMMUNITYEDUCATIONPROGRAMME........................................................................................345.1. StaffInformation.........................................................................................................................................345.2. ActivitiesunderEducationProgramme.......................................................................................................35

5.2.1. EducationAccessProgramme..............................................................................................................355.2.2. SchoolSupportProgramme.................................................................................................................395.2.3. GirlsEmpowermentProgramme.........................................................................................................405.2.4. EmpoweringParentsandSchoolManagementCommittee................................................................415.2.5. ChildRightsProgramme......................................................................................................................425.2.6. HealthEducationProgramme..............................................................................................................42

5.3. TechnicalSupportfrompartnerorganisations............................................................................................435.4. SuccessStories.............................................................................................................................................44

6. CHAPTER6:RECONSTRUCTIONANDRELIEFPROJECTS.......................................................................................456.1. SanitationSupportProjectinSindhupalchok:.............................................................................................45

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6.2. ResilientRehabilitationoftrailinhighlyearthquakeaffectedcommunitiesofGorkha..............................456.2.1. Objectivesoftheproject:....................................................................................................................466.2.2. AchievementsonlabourRegistration:.................................................................................................466.2.3. Totalnumberofworkers:....................................................................................................................466.2.4. TargetVsAchievementfortrailrehabilitation:...................................................................................47

6.3. PrefabHealthPostconstructioninGorkhaandSindhupalchok..................................................................486.4. SchoolreconstructioninGhurdandaVDCofSyangja..................................................................................496.5. SuccessStory...............................................................................................................................................50

7. CHAPTER7:STAFFCAPACITYBUILDINGANDMISCELLANEOUS..........................................................................517.1. Bi-annualMeeting.......................................................................................................................................517.2. HealthTraining:...........................................................................................................................................527.3. SocialMobilizationTraining:........................................................................................................................527.4. Livelihoodtraining:......................................................................................................................................527.5. EducationTraining.......................................................................................................................................537.6. ScholarshipSupportforPHASEANMstoStudyNursing.............................................................................537.7. VisitorsfromAbroad....................................................................................................................................53

7.7.1. GlobeMedatTufts...............................................................................................................................537.7.2. SkilledVisitorsfromPHASEWorldwide...............................................................................................54

7.8. NishaTamangMemorial..............................................................................................................................568. CHAPTER8:COORDINATION,NETWORKINGANDMONITORING........................................................................57

8.1. Support,Monitoring,Partnership&Networking........................................................................................578.2. PHCWorkshop.............................................................................................................................................588.3. ExternalEvaluations:...................................................................................................................................59

8.3.1. EvaluationofICDPbySocialWelfareCouncil(SWC)...........................................................................598.3.2. SWCEvaluationofWASHrecoveryProject.........................................................................................598.3.3. ExternalEvaluationofUKAidGPAFProject,FarWestNepal..............................................................59

8.4. PromotionsandMarketing..........................................................................................................................60

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ABBREVIATIONS AND ACRONYMS ANC Antenatal Care

ANM Auxiliary Nurse Midwife BCG Bacille Calmette-Guerain (TB vaccine)

CBO Community Based Organization CB-IMNCI Community Based Integrated Management of Neonatal and Childhood Illness

CDP Community Development Programme CGI Corrugated Galvanised Iron

CHP Community Health Programme CMA Community Medical Assistant

DAO District Administration Office DADO District Agriculture Development Office

DEO District Education Office D(P)HO District (Public) Health Office/r

DPAC District Project Advisory Committee DPT Diphtheria, Pertussis and Tetanus

ECD Early Childhood Development EDF Education Development Facilitator

FCHV Female Community Health Volunteer FY Fiscal Year

GESI Gender, Equity and Social Inclusion GO Government Organization

GP General Practitioner HA Health Assistant

HDI Human Development Index HFMC Health Facility Management Committee

HiB Haemophilus Influenzae B IPV Injected Polio Vaccine

JTA Junior Technical Assistant (Agriculture Technician) MG Mother’s Group

MPI Multidimensional Poverty Index NGO Non Government Organization

NTTI Nepal Teacher Training Initiative OJT On the Job Training

OPD Outpatient Department OPV Oral Polio Vaccine

ORS Oral Rehydration Solution / Salts PHASE Practical Help Achieving Self Empowerment

PHC Primary Healthcare Centre PNC Postnatal Care

PCV Pneumococcal ConjugateVaccine

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PwD People with Disabilities

SBA Skilled Birth Attendant SLC School Leaving Certificate

SM Social Mobilizer SWC Social Welfare Council

SODIS Solar Disinfection Method TB Tuberculosis

ToT Training of Trainers TT Tetanus Toxoid

VCC Village Cleaning Committee VDC Village Development Committee

WASH Water Sanitation and Hygiene HiCAST Himalayan College of Agriculture Science and Technology BoQ Bills of Quantity

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1 CHAPTER1:PROGRAMMEEXTRACTANDMAJORHIGHLIGHTS

1.1 IntroductionPHASE Nepal believes in a self-empowered and self-sustained society where all kinds of discrimination are absent; PHASE’s objectives are to improve the livelihoods of rural people by providing immediate support and health care services and by empowering communities. Through its Community Development Programme, PHASE Nepal works in health, education and livelihood programmes. This year, PHASE conducted its core programmes in 24 extremely remote VDCs of 6 districts in 4 development regions. Apart from the ongoing programmes, after the devastating earthquake of 25th April 2015, PHASE Nepal started to work in relief and reconstruction projects and this work continued through this financial year.

Figure 1: PHASE Nepal Theory of Change

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1.2 Healthprogramme Together with the Government staff present in respective health posts and ORC clinics PHASE Nepal provided following services:

• 916 child births were supported by skilled health workers. • 1158 pregnant women visited at least once (ANC 1st) in these clinics. During such

visits the women got medical check-ups, received iron tablets and got Albendazole (deworming tablets) from these clinics.

• 840 new born babies had health checks from these clinics. • 17,046 children under 5 yrs of age were treated, among them 8924 were male and

8122 female. • 18,738 children were monitored for their growth of which 1805 were underweight

making it approximately 10% of the total children monitored. • 1489 sessions of door-to-door visits were organized. • 3630 people benefitted from counselling on family planning. • 284 school health events were organized beneffitting 8744 children and 426 events of

community health educationwere organized to raise awareness of diarrhoeal diseases beneffitting 7039 people.

• 194 events of orientation for FCHV and Mothers group were conducted beneffitting 7742 women.

• A total of 101,222 people; male 43,834 and female 57,388 beneffitted from OPD services provided in PHASE Nepal supported clinics, a significant increase of 10% compared to the previous year.

1.3 Livelihoodprogramme• 2404 farmers received support and training across 6 districts. • 618 farmers beneffitted from training on chicken rearing. • 46 trainings were conducted on vegetable production including cultivation practice of

maize. • 22 events of training on fodder planting and management was conducted beneffitting

480 farmers. • 15 events training on low cost water irrigation was provided that benefitted 429

farmers. • 185 framers received training on improved farming technique.

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1.4 EducationProgramme• 302 teachers received best teaching practices training. • 69 students are studying in alternative education (flexible schooling program) class in

Yarchyo and Taju Alternative Primary School in Chumchet VDC of Gorkha. • 323 women completed adult literacy classes in in 2 batches conducted in Muguand

Bajura district. • Health education program was organized in 145 schools. • Sports support program was conducted in Gorkha, Bajura and Okhaldunga. • Girls empowerment program for 272 girls from Bajura.

1.5 EarthquakeReliefProjects• After the devastating earthquake of 25th April 2015, PHASE immediately started

working on providing relief with priority in its existing projects areas, but benefitting other areas as well. After concluding emergency relief, PHASE also started to work in reconstruction projects.

• Landslide affected families in Bajura has been provided rice, tarpaulin, blankets, salt, pulses and cooking oil. PHASE Nepal also handed over the following tool sets to the DDRC Gorkha: crow bars-15, claw hammers-15, 5 kg hammers-15, 16” handsaw 15, shovel - 49, pick - 40, nylon rope 15 rolls and first aid box with medicine -40. The tool sets will be used for immediate search and rescue at the time of disaster under the guidance of DDRC. •

• 820 HHs received material and support to construct individual toilets benefitting 4,848 people in Sindhupalchok.

• About 81% of 69.67KM of trail has been rehabilited under Unnat Goreto Project (DFID/PIN/SW/PHASE) benefitting from Cash in highly affected communities in Manbu (16.74 km), Kashigaun (19.26 km) and Kerauja (33.67 km) of Gorkha.

• 1 storeyed school building with 4 classrooms has been completed in Ghurdanda, Syangja.

• Prefab health post construction in Kashigaun and Kerauja has been completed and in the process of handover.

• Construction of 43 drinking water schemes in six earthquake affected VDCs (Hagam, Baramchi, Selang, Pangtang, Jalbire and Fulpingkot) in Sindhupalchok completed under the WASH recovery project. (43 schemes had been completed in the previous financial year under this project)

1.6 Stafftrainingandotheractivities• PHASE staff took part in regular bi-annual training on different topics. According to

performance and after evaluation, need based training was implemented. • Biannual health training was conducted in PHASE office. General health update

training on midwifery, CB-IMNCI, Fracture Management, CPR, Poison Case Management, Peptic Ulcer Disease and practical skills was provided by volunteer doctors, midwives and obstetricians from UK. 8 days contraceptive implant training was provided to 4 selected health staffs in cooperation with FPAN.

• 2 days training on soil fertility management had been conducted in HiCAST social science lab and field for 18 field technician working in remote areas of Gorkha, Mugu, Bajura, Humla and Sindhupalchok.

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• Training on interactive classroom activities, story telling, phonics, early childhood education, play way method of learning and classroom management was provided to the education staffs at PHASE office during their visit for annual meetings in central office Kathmandu.

• 14 GPs from the UK visited the project areas to further strengthen the capacity of the staff through in post mentoring. 8 volunteers from the UK supported the health training in obstetrics and general health update in Kathmandu in October and April.

• 3 students from Jiri technical school completed their on the job training in health (ANM) and 4 in the agriculture programme.

• 3 teacher volunteers from the UK visited PHASE Nepal and supported in staff development and developing monitoring frameworks.

1.7 Coordination,NetworkingandMonitoringCoordination and networking meetings have been conducted at all levels of project implementation and government administration. Signed MoU with Ministry of health, Department of Agriculture, Department of Livestock and Department of Education. Similarly, Coordination visits have been made to respective districts DHO, DEO offices. Besides PHASE’s regular involvement in review meetings, DPAC meetings have been conducted in districts. With Funding from the Austrian Development Cooperation and in coordination with the National Health Research Council, Ministry of Health and University of Sheffield, PHASE Nepal also organised a Workshop on 26th April 2017 which addressed the challenges of delivering Primary Healthcare in Remote Rural Areas of Nepal.

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2. CHAPTER2:ORGANIZATIONALINFORMATION Practical Help Achieving Self Empowerment (PHASE) Nepal is a not for profit, non-government, nonpolitical, non-religious, equal opportunities, social development organization founded in 2006 by a group of professional development workers, who have been engaged in national and international development organizations in Nepal for many years. PHASE specializes in improving health, education services and livelihood opportunities for disadvantaged populations in very remote and resource poor Himalayan mountain villages in Nepal. PHASE aims to support the most vulnerable people to break the cycle of poverty; by assisting communities and local authorities to lay the groundwork for a self-sufficient future. PHASE believes that poor health, low educational levels and poverty are all aspects of the same problem, and create a cycle preventing people from taking control of their own future; PHASE aims to address these aspects simultaneously, through integrated Community Development Programmes (CDP) which empower individuals and communities on all levels. PHASE has special emphasis and expertise on working in extremely remote areas - areas in the high Himalayas, with scant resources, a harsh climate, difficult terrain, and little or no access to basic services. These are areas often neglected by development NGOs, being too difficult and expensive to manage successful projects in. PHASE’s philosophy is to work in areas of greatest need, which is extremely challenging but is also an area in which we have had extensive success. Our target communities have experienced rapid change in short periods of time – for example, areas with no functioning health system and no access to or trust in modern medicine are provided with a high standard of primary healthcare and preventative education. Beneficiaries learn to use and trust the system extremely rapidly and within months a PHASE health post can see between 30 and 60 patients a day. Since its inception in 2006, PHASE has treated over 550,000 patients and can confidently assert that on average our health workers save at least one child’s life every month. Similarly, the organization has contributed to more than 1,400 household toilets and improved livelihood opportunities for over 15,000 people in 21 VDCs. These are staggering figures that can’t be claimed by many other organizations. The success of our projects under such challenging circumstances can be attributed in large part to our main asset: our staff team. We have a strong and supportive volunteer board, a talented group of highly motivated support staff in the central office, and a hardworking and brave team of young, mostly female field staff. PHASE Nepal’s main funding partners include PHASE Worldwide, PHASE Austria, Lindsay Cooper and Nepal Teacher Training Innovations and more recently Eco Himal, the Austrian development Agency, Caritas Austria, Caritas Germany, Diakonie Katastrophenhilfe (Germany), People in Need, the Himalayan Development Foundation Australia and other Humanitarian Aid and Development organisations. PHASE works to establish various support networks and partnerships with government and non-government agencies as well. As of July 2017 PHASE has 107 full time staff and is working in 25 remote VDCs of Bajura, Humla, Mugu, Gorkha, Kavre, Sindhupalchok districts in Nepal.

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2.1. Vision&ObjectiveVision A Self-empowered and self-sustained society; where all kinds of discrimination are absent. General Objective To improve the livelihoods of rural people by providing immediate support through health care and education services and empowering them. Specific Objective

• Help people in the selected areas to provide better education to their children in an adequate environment.

• Make people aware about health and hygiene providing health education and supporting high quality primary health care services.

• Help the community to develop relatively safer and sustainable water supply infrastructures and train on health and sanitation aspects of water supply.

• Improve education opportunities for children and adults in rural communities and contribute to improving the quality of formal education services. Help in refurbishment of the community properties.

• Support people’s livelihoods, particularly through access to improved agricultural techniques.

• Assist affected communities in recovery and reconstuction after the devastating earthquakes of April and May2015.

2.2. ProgrammeComponentsPHASE believes that lack of opportunity, equity and access are all aspects of poor health, low educational levels and poverty, and pursues an integrated approach to create opportunities among the communities of isolated hill areas. Basic health services: general treatments, safe delivery, family planning, behaviour change, health education, child health and nutrition. Education: Adult literacy, early childhood development classes and flexible schooling programme, school teacher and library support, teacher training, scholarship to poor pupils and infrastructure improvement. Agriculture and livelihoods: training and supporting farmers to increase productivity of high value crops, livestock, medicinal and aromatic plants and their marketing. Gender, governance and social inclusion: women are the main priority while planning and implementing the programme. Specific gender programme includes girls empowerment projects and Adult Women Literacy programme. Infrastructure development: basic infrastructures such as school buildings, water taps, toilets, furniture, community buildings and others. Relief, recovery and reconstruction: immediate relief to the affected families in the PHASE project areas, support for recovery and reconstruction with people centered build back better approach. Strengthening institutional capacity of groups: small scale saving and credits, group registration to local governmental authority, leadership development. Conflict mitigation and social justice: conflict victims, returnees, disabled and otherwise disadvantaged persons are always at the centre of our focus.

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2.3. Approach&StrategyPHASE Nepal always appreciates and respects positive endeavours from individuals, communities and national and international governmental and non-governmental organizations. The organization always takes into consideration the following approaches during the programme implementation process: Participatory approach: We encourage our beneficiaries to participate actively in our programmes right from the needs assessment to the implementation, monitoring and evaluation, and sharing of lessons learned. People centred approach: Community people are central to all our development efforts and interventions. Coordination and collaboration approach: Activities are coordinated with governmental and nongovernmental organisations at grassroots, district, national and international levels. Accountability and transparency: All the programme activities and corresponding budget allocated for that particular programme are transparent; anyone at any time can have access to this information, if requested. Demand driven approach: Programme activities will not be imposed from the top, but are selected based on the informed choice demand driven approach and requests made by the beneficiaries. Needs driven approach: PHASE always tries to plan and select project areas and activities according to highest need The organization consistently embraces the following principles while implementing the programmes: Integration: PHASE Nepal makes every effort to promote integrated approaches in its project areas. PHASE believes that the successful integrated model of health, education and livelihood activities empowers and helps communities to break the cycle of poverty and to improve their futures. GESI: PHASE works with vulnerable people across resource poor remote communities, but specifically within these communities' women, children and the most underprivileged people are the focus of our programmes. Human Rights: PHASE Nepal is guided by its humanitarian policies which actively nurture all aspects of human rights from within our programmes. HDI/MPI & Cluster: When selecting project areas PHASE Nepal analyses available information about the geographical clusters based on the Human Development Index and Multidimensional Poverty Index. PHASE also collects baseline information to find and set the key indicators before any programme intervention. Ownership & sharing: In PHASE projects, local stakeholders are involved in the decision-making process and community activities are carried out with local participation during the course of project implementation. Efficient community participation, cost sharing and coordination with government line agencies create community accountabilities and ownership of the project.

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Bottom-up: PHASE ensures that local actors participate in the selection of the priorities to be pursued in their local area and in decision-making about the strategy. By involving, combining and interacting with local communities, better overall results are achieved more easily. Sustainability: As far as possible, PHASE strives to ensure that benefits realised by organisational and community based activities supported through community development projects continue after the end of the project.

2.4. ProjectInformation

PHASE Nepal has been continuously working in Health, Education and Livelihood programmes since 2006. After the devastating earthquake in Nepal in April 2015, PHASE has also been working on reconstruction and recovery programmes in the districts worst affected by earthquake namely; Gorkha and Sindhupalchok.

Details of all projects are listed below:

2.4.1. Community Development Programme (CDP) Table 1: Projects under CDP

SN Projects District VDC 1. Community Health

Project Gorkha Keraunja, Kashigaun, Manbu

Sindhupalchok Hagam, Fulpingkot, Baruwa, Bhotang

Humla Maila, Melchham, Jair

Kavre Rayale

Bajura Kolti , Bichhaiya, Rugin , Wai

Mugu Dhainakot, Natharpu, Hyanglu, Ruga, Kotdanda, Photu

2. Community Education Project

Gorkha Chumchet, Keraunja, Kashigaun

Sindhupalchok Hagam, Fulpingkot

Okhaldunga Rawadolu Kabhre Rayale Humla Maila, Melchham, Jair Bajura Rugin, Wai, Kolti and Bichhaiya

Mugu Ruga, Kotdanda, Photu, Dhainakot, Natharpu, Haynglu

5. Livelihood Project Sindhupalchok Tauthali, Piskar

Gorkha Kashigaun, Keraunja

Humla Maila, Melchham, Jair

Bajura Wai, Rugin, Bichhaiya, Kolti

Mugu Dhainakot, Natharpu, Haynglu, Ruga, Kotdanda, Photu

Total 7 Districts 25 VDCs

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2.4.2. Emergency Relief Project Table 2: Projects under Relief and Recovery SN Projects District VDC

1. Recovery Gorkha Keraunja, Kashigaun, Manbu

Sindhupalchok Tauthali, Hagam, Fulpingkot, Jalbire, Selang, Pangtang, Thumpakhar, Baramchi, Piskar

Syanja Ghurdanda

Okhaldhunga Rawadolu 2. Emergency Relief for

flood victims Bajura Humla

Rugin Jair

Total 6 Districts 16 VDCs

2.4.3. Map of Project Areas

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2.4.4. Project Funding Partners: PHASE Worldwide UK with funding from UKAid, Guernsey Overseas Aid, Innocent Foundation and Big Lottery fund (BLF), PHASE Austria with funding from City of Vienna and Ministry of Sports, Lindsay Cooper, Global Giving, NTTI, GlobeMed, EcoHimal,ADA, Diakonie, HDFA, Caritas Germany, Caritas Austria, Chay-Ya, NERA, Doctors for Nepal and few individual donors.

2.5. StaffStructure:

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2.6. SourcesofInformationSources of information are primary as well as secondary. All population details have been extracted from VDC level National census 2011. Programme data have been taken from monthly reports sent from field staff to head office i.e. health reports, education reports, livelihood reports and earthquake relief and reconstruction reports.

2.7. StructureofReportThis report has 8 chapters. Chapter one contains major highlights and achievements of PHASE Nepal during the year 2016-17, Chapter two contains a brief introduction of PHASE Nepal’s working strategy and details of projects of PHASE. Chapter three describes community health programme achievements, its challenges and possible solutions. Chapter four contains details of the livelihood programmes. Chapter five describes education programme achievements. Chapter six describes Emergency Relief and Recovery Projects initiated after the Earthquake. Chapter seven describes Staff capacity building activities and other additional activities. Chapter eight describes coordination, monitoring and networking.

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3. CHAPTER3:COMMUNITYHEALTHPROJECT PHASE Nepal works on Health Programme in close coordination with the Ministry of Health, district health offices and other district level government stakeholders. The community health program is aligned with United Nations Sustainable Development Goal no.3 which aims to “Ensure healthy lives and promote well-being for all at all ages”. PHASE provides basic essential health care services, prioritising maternal and child health at top most. PHASE is working in very remote areas where road access is far away. Regardless of the difficult geographical and cultural barriers, PHASE staff have been successful in providing services regularly.

Figure 2: Training on Management of Acute Malnutrition to FCHVs (Maila, Humla)

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3.1. StaffInformationHealth supervisors and ANMs are the frontline project staff to undertake the project activities at the community level and to support the health posts. Altogether 40 health staffs (1 Project Manager, 7 Health Supervisors, 32 ANMs- 3 are local ANM and other 6 are trainee ANM) have been working in health projects during this reporting period, 3 of whom are male. The main role of the health supervisors is to coordinate with district, VDC and local stakeholders to implement the project activities, provide health service in the health post as well as to monitor and help to resolve the problems if any during the intervention and to communicate with the project manager on ongoing progress. ANMs provide health services in the health post and conduct awareness activities in the community. Trainee ANMs support the ANMs and Health Supervisors to implement the project activities. Project Manager guide and support the field staff in implementation activities and communicate with senior management and donors.

3.2. MaternalHealth A total of 1,158 pregnant mothers received first antenatal care services during this reporting period, more than the target set at the beginning of the year. The target for the 1st ANC visit was achieved in all the VDCs but there is still room for improvement for 4th

ANC visits: 523 women received 4 visits, 45% of all antenatal patients. This is 80% of the target (target 648). Nevertheless, this is a significant improvement on last year, when only 76% of the target was achieved – in 2015/16 38% of women who had ANC achieved 4 visits. 916 safe deliveries were carried out by skilled attendants, mostly PHASE Nepal staff. The highest number of deliveries was recorded in Kolti Primary Health Centre (120). 981 mothers and babies got at least one postnatal (PNC) service during the period and all the pregnant women were sent to nearest government institution for TT vaccine. Table 3: Maternal Health District VDCs Target vs. ANC ANC Deliver PNC

Achievement 1st 4th y Sindhupalchok 2 Target 141 48 60 95

Achievement 130 30 86 86

Humla 3 Target 275 119 106 108

Achievement 280 79 176 146 Gorkha 6 Target 108 102 40 40


Bajura 4 Target 300 200 193 364


Kavre 1 Target 25 16 11 20


Mugu 6 Target 210 163 50 50 (2months)


Total 24 Total Target 1059 648 460 677 Achievement 1158 523 916 981

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3.3. ChildHealthChildren are very vulnerable due to their lower immunity power and because they cannot access health services by themselves without support. Child health is still a big problem in the project area. PHASE Nepal’s community health activities include child health care, emphasised on CB-IMNCI (Community Based Integrated Management of Neonatal and Childhood Illness); a standard set by government health policy of Nepal. PHASE health service includes support to immunization services, distribution of deworming tablets in schools, CB-IMCI and nutrition training to FCHV and Mothers’ Group, child monitoringfor nutrition status and counselling to parents of undernourished children. PHASE Nepal also organizes school health education in each school of the project area once a month in different topics according to need of area. 840 neonates, 412 female and 428 male, were examined for assessing their health condition. Table 4: Child HealthOutput Indicators Beneficiaries

Male Female Total

Albendazole distribution 2,161 2,183 4,344 OPD service <= 5 yrs 8,924 8,122 17,046

Albendazole (deworming tablets) was administered to 4,344 children and total 17,046 children under the age of 5 years were seen and treated at health posts and ORCs. PHASE staff supported various immunization events to government institutions throughout the year where children were immunized in 22 health posts of the project area. The immunization follows the Nepal EPI programme including BCG, DPT Hib Hep B, OPV,PCV, Measles & Rubella, IPV and Japanese Encephalitis. Among children under 5 years of age that were examined, 1898 suffered from pneumonia and 6468 children suffered from diarrhoea.

428412

NewbornExamina6on

Male

Female

020040060080010001200 944 1002 954 867

1167

Childrena:endingvaccina6on

Childrenagendingvaccinahon

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Table 5: Children affected by diarrhoea and pneumonia Caste Children Affected by

Diarrhoea Children Affected by pneumonia

Dalit 3,346 518 Janajati 584 257 Brahmin/Chettri 2,148 914 Others 390 209 Total 6,468 1,898

Children under 5 years age of are regularly monitored to ensure that the development and growth of children is normal. Figure above shows three years trend of children monitored and data reveals that the number of underweight children identified has increased. In FY 2014/15, 6 percent children were found to be under weight and in FY 2015/16 underweight children were increased to 10 percent among monitoredvery likely due to the project expansion into very deprived areas. In the fiscal year 2016/17, the total nuber of children monitored has increased over two-fold, the proportionof underweight children identified has remained around 10 percent.

9974

7374

18738

645746

1805

0

200

400

600

800

1000

1200

1400

1600

1800

2000

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

2014/15 2015/16 2016/17

No.ofchildrenmonitored

No.ofmalnourishedchildren

Childrengrowthmonitoredvsmalnourishedchildren

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3.4. FamilyPlanning Family planning service is an important part of PHASE community health activities; thus increasing availability and access to quality family planning services is a key priority of PHASE. PHASE Nepal staff provide family planning counselling to the clients who visit for postnatal care service as well as general temporary family planning services. In addition PHASE staff also organize community health education sessions in each ward of the village and provide counselling for temporary family planning services.

Table 6: Family Planning Service Contraceptives Beneficiaries

Male Female Total Family planningcounseling 1356 2274 3630

Depo-provera - 4390 4390 Pills - 2069 2069 Implant - 192 192 Condom (piece) 2179 - 2179 Within this reporting period, PHASE health staff injected 4,390 vials of Depo-Provera (a three monthly contraceptive injection for women). Similarly, 2,069 women took contraceptive pills at least once from PHASE health post and 192 women had a contraceptive implant (effective for 5 years) inserted. 2,179 individuals received condoms from the health posts and 3630 people were given counselling for temporary family planning services, around 2/3 of them women.

3.5. HealthAwarenessRaisingActivities Table 7: Health Awareness Raising Activities Target Achievement Beneficiaries

Male Female total

Calendar for health promotion 21 VDCs 21 VDCs

Street drama event 16 26 938 1,533 2,471

Day celebration event 16 44 - - -

School health education 190 284 4,036 4,708 8,744

Community health education 305 426 1,938 5,101 7,039

Door to door health education 744 1,489 4,316 8,103 12,419

Clinic health education 408 623 2,433 4,317 6,157

Super flour making demonstration 82 34 157 680 837

Participatory village cleaning 176 252 697 3,382 4,079

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Apart from clinic services, public health is also a priority programme of PHASE Nepal’s work. It is essential to increase awareness everywhere in the community - amongst opinion leaders, decision makers, community leaders, parents, teachers, children and health professionals. PHASE Nepal planned several community-based participatory activities to increase health related awareness, knowledge and skills. The activities were focused on the situation and needs of the community. PHASE health staff teach about safety, first aid, personal hygiene and cleanliness and about adolescent health to the schoolchildren of 13-16 years of age. With the objectiveof improving children’s nutrition status, super flour (weaning food) making orientation events were run in which 837 parents took part.

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3.6. LocalCapacityBuildingTable 8: Training/Orientation to Local Stakeholders Capacity Building Activities Event Male Female Total

FCHV & Mother group 194 364 7742 8106 Orientation Traditional Healers Training 28 590 267 857

Public Audit 35 1042 1028 2070

Total 257 5072 3585 8657

194 events related to health and hygiene for FCHVs and mothers group were conducted. A total of 8106 people participated in these events. Similarly, with the objective of empowering traditional healers and setting up referral mechanisms, 28 traditional healers’ trainings were organized where 857 traditional healers participated. Maintaining good governance, following accountability and for maintaining transparency PHASE Nepal organised biannual public audit program in every working VDC.

Table 9: Meeting Facilitation to Local CBOs (Community Based Organisations)

Capacity Building Activities Event Male Female Total

FCHV meeting facilitation 170 388 1899 2131

HFMC meeting facilitation 101 966 542 2219

Mothers group meeting 367 362 7322 5072

Total 638 1716 9763 12117

FCHVs meeting are conducted once a month in each VDC. Health facility management committee meeting was conducted 101times and Mothers group meeting was conducted 367 times. The optimum use of local resources depends on capacity of the local stakeholders; therefore, PHASE health staff encouraged local functioning bodies such as HFMC (health facility management committee), FCHV (Female Community Health Volunteers), MGs (Mothers Groups) and VCCs (Village Cleaning Committees) to organize meetings every month. In these meetings PHASE health staff help local CBOs to find the local resources, identify problems in the community regarding health related issues; find the solutions of these problems and assist them in decision making. PHASE staff also organise orientation on basic health rights, duties, roles and responsibilities of being a member of such CBOs and community member.

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3.7. Clinicalservices PHASE Nepal is a growing organization and as a result the reach to beneficiaries is also increasing every year. Patients from adjacent VDCs also come to access PHASE Nepal’s services in the project areas. A basic essential primary health service has been provided regularly from Health posts and outreach clinics, supporting and supplementing the government services, and the number of people benefitting is increasing every year.

The figure above shows patients attending clinic for medical care other than ANC, PNC, delivery and family planning services. According to data in fiscal year 2014/15 and 2015/16 total 75,962 and 90,637 patients were examined respectively. In the fiscal year 2016/17 the number of direct beneficiaries from health services has increased to 101,222. PHASE has achieved success in reaching out to highly vulnerable people in remote areas: Most of the beneficiaries are Janajati (ethnic minority) and Dalit (low caste) and well over half are female. Table10: Caste wise distribution of OPD beneficiary Caste Male Female Total

Dalit 11,303 14,549 25,882 Janajati 8,396 11,950 20,346

Muslim 18 22 40 Brahmin / 18,211 24,107 42,318 Chhetri

PwD - - - Others 5,906 6,730 12,636

Total 43,834 57,388 101,222

0

20000

40000

60000

80000

100000

120000

2014/15 2015/16 2016/17

75962

90637101222

No.ofOPDBeneficiary

No.ofOPDBeneficiary

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3.8. Issues,Challenges,Recommendation Table 11: Issues in Health programme Issues and Challenges Recommendation Responsibility

4th ANC is still low compared to 1st ANC

continue to raise awareness through ANC groups, house to house visits and individual health education; incentives

Field Staff/ Health Supervisor

Still high rates of home delivery in some areas

ongoing awareness raising and consider incentives

Field Staff/ Health Supervisor

Significant number of Malnourished/ underweight children

continue nutrition workshops, child weight monitoring and integrated activities to improve childhood nutrition

Field Staff/ Health Supervisor Program Unit

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3.9. SuccessStoriesProlonged labour but twin babies delivered successfully and safely Humla district is still not connected with road so access to the district is only through plane which operates from only district headquarters and from there one has to walk to the remote villages of the district. PHASE Nepal has been working in Humla district for over 8 years now and has been providing health and education services. It has been working in some of the most remote VDCs in the district. Maila is one of the very remote VDCs of Humla situated at a distance of 48 miles from the district headquarters. The people were excluded from even basic health facilities before PHASE Nepal started working in the VDC. People now visit the Health post where PHASE Nepal provides health services and free medicines to the people.

Mrs. Putla, a 45 year old woman was pregnant. It was the 13th time she had become pregnant and all her previous pregnancies were successful bearing 12 offspring. When she started suffering from labour pain her husband rushed her to the health post where PHASE Nepal health staff work with government staff. The government staffs were not present but health staffs of PHASE Nepal were present. Upon inspection it was found that she had twins in her womb hence health staff informed her husband to take Mrs. Putla to either Nepalgunj or Kolti and gave him a referral letter for the same. But because of the poor economic status and the time needed to take her to any of the places, her husband requested the health staff to deliver the babies in Maila health post. He also signed a consent letter for this. The first baby was delivered at around 5 in the morning. The health staff informed him that the other twin baby should be delivered within two hours, if not then she had to be taken to Kolti. Putla's husband was advised to prepare for the travel logistics and expenses. He went to his village to arrange for funds but had to return empty handed. The two hours had passed and PHASE health staffs were worried. Their expertise in such cases was limited hence to save her life; they contacted experts in Kathmandu for advice and guidance. From the telephonic instructions they were able to deliver the second twin baby at 12.55 in the noon. It is rare that a live twin is delivered after such a prolonged period. Although it was a case of prolonged twin delivery, both the babies were in vertex position hence the advice and guidance of experts enabled the health staff to deliver the second twin even after prolonged period. Putla's husband is thankful to health staff of PHASE Nepal for saving the lives of his wife and twin babies.

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4. CHAPTER4:LIVELIHOODPROGRAM PHASE’s vision includes supporting resilient livelihoods of rural people and improve their nutritional status through a set of farm based income generating interventions. The community livelihood program is aligned with United Nations Sustainable Development Goal no. 2 which aims to “End hunger, achieve food security and improved nutrition and promote sustainable agriculture” and Goal no.12 which aims to “Ensure sustainable consumption and production patterns.” The main focus is to bring change in the traditional method of subsistence farming practice ensuring increased crop and livestock yield and diversification. Increased yield ensures improved livelihood and nutritional status of the poorest farmers. Capacity building of farmers through farm based agriculture and livestock training followed by support with improved seeds, breeding animals and regular door to door visits enables farmers’increased capacity. Seasonal and offseasonal vegetable production under plastic tunnel and alternative irrigation system, improved poultry production, local goat breed improvement with improved breeding buck support are key interventions that increase the farmers’ income, eventually contributing towards livelihood and nutrition improvement. During this reporting period ( FY73/74; 2016/17), PHASE supported 2404 farmers including 400 in Humla and Bajura, 1351 in Mugu and Bajura, 228 in Gorkha and 425 in Sindhupalchok. The livelihood component of PHASE has been supported by various donors. PHASE Worldwide is supporting them with funding from Department for International Development ( DFID ) in 3 VDCs of Humla and 2 VDCs of Bajura, Big Lottery Fund (BLF) in 2 VDCs of Gorkha, Caritas Germany in 2 VDCs of Sindhupalchok, Guernsey Overseas Aid Commission (GOAC) and Innocent Foundation UK in 6 VDCs of Mugu and 2 VDCs of Bajura.The livelihood project in these 8 VDCs is also supported by the Austrian Development Cooperation (ADA).

4.1. StaffInformation JTAs, social mobilizers and supervisors are the front line project staff to undertake the project activities at the community level. Altogether 19 staffs have been working in livelihood projects this reporting period, 5 of whom were female. The main roles of the JTAs is to provide technical guidance and information to the farmers. The Social Mobilisers are responsible for social mobilization, facilitating group formation and to support the technical staff in getting acquainted with the community people and the local agencies. Field supervisors provide backstopping support to JTAs in undertaking the technical activities. Project Managers guide and support the field staff in implementation activities and communicate with senior management and donors.

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4.2. SpecificProjects:

4.2.1. Integrated Programme for the health of women and children in Far Western Nepal (Bajura, Mugu)

The project is co-funded by Australian Development Agency and PHASE Worldwide (with funding from GOAC and Innocent Foundation). The working areas of the project are Mugu district 6 VDCs- Dhainakot, Natharpu, Haynglu, Ruga, Kotdanda, Photu and 2 VDCs namely Rugin and Bichhaiya of Bajura district. The project will be implemented till 2018. The total beneficiaries of the project are 1,351 farmers. Table12: Major activities and beneficiaries –June 2016 to July 2017(Mugu and Bajura)

S.N. Activities Events Beneficiaries 1 Monthly meeting with Ag. Group 178 1,351 2 Nursery Observation 140 109 3 Field Visit and technical advice to farmers 178 1,071 4 Polytunnel construction training 8 246 5 Improved vegetable seed support 2 1,351 6 Training on vegetable production 20 1,351 7 Orientation on vegetable production 20 1,351 8 Training on animal husbandry 6 338

9

Plastic sheet 600 guage support to close plastic tunnel and promote vegetable production in winter season

1 200

10 Drip irrigation 1 150 11 Female goats Distribution 1 130 12 Stud goats Distribution 1 17 13 Training on improved goat house 6 147

14 Training on fodder planting and management 6 147

15 Training in chicken rearing training 6 600

16 Training in chicken rearing Re-fresher training 6 600

17 Chicks distribution 1 489

.

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4.2.2. Integrated Project for Earthquake Recovery (Gorkha) PHASE Worldwide has received a grant form Big Lottery Fund (BLF) UK for 5 years Integrated Community Development Project to be implemented by PHASE Nepal in 2 VDCs of Gorkha district (Kashigaun and Keraunja). 19 farmers groups including 9 in Kashigaun and 10 in Keraunja comprising 219 total members have been formed with female and male proportion of 203 and 26. Total 19 slots of orientations (6 on dual-purpose improved poultry production including improved goat shed construction and 13 on improved vegetable production inside the plastic tunnel) have been conducted. Major agriculture and livestock activities: 19 Farmer groups formed. There were 228 farmers (26 male 202 female) in the group.The farmers in these groups were provided with:

Ø 3 days training on vegetable production and poultry farming in 9 events Ø 3 days training on offseason vegetable production and the cultivation practice of maize -

9 events Ø plastic sheet (silpoulin) for constructing poly tunnels Ø 8 fruit saplings (6 pear and 2 plum) to 228 farmers Ø 36 farmers received 220Kiwi saplings in total Ø Improved seeds of maize. (2 kg/HH) Ø Vegetables seeds including cress, Spinach, Carrot, Coriander Broad leaf mustard, tomato,

cucumber, pumpkin, radish and bitter gourd (kitchen garden promotion). Ø Feeder and water pots for poultry Ø Irrigation materials (e.g water can and loose pipe) Ø Ten poultry chicks distributed to each of 228 households - improved breed (Giriraj) with

complete vaccination Ø NRS. 2,100 (just over £15) cash support to construct semi-intensive chicken coops.

4.2.3. Livelihood Recovery Project Sindhupalchok Livelihood Recovery Project with the financial support from Caritas Germany has been implemented in 2 severly earthquake affected VDCs- Tauthali and Piskar of Sindhupalchok district. It is a 3 year project and has been started from January 2017. A total of 425 HHs belonging to 22 farmers groups were considered for project support for the first year. The information obtained from baseline survey included:

Ø The project had a cumulative coverage of 425 HHs having a population of 2,328 (29.5% of total VDC population). These HHs were engaged in 22 different existing farmers groups (12 in Tauthali and 10 in Piskar VDC).These farmers group were mostly established by Poverty Alleviation Fund (PAF), DADO and others.

Ø Agriculture sector comprises a major source of income, employment and food consumption for 95 % of the beneficiaries HHs. 86 % of the beneficiaries reported their annual food availability for less than six months from their own agriculture based business. Thus, these HHs were considered as prioritized HHs for project intervention. The selection of the HHs was also based upon the degree of vulnerability after the earthquake in 2015.The average cultivated area reported by the beneficiaries was only 7.47 ropani (0.37 ha) which is below the national average.

Ø About 65 % of the HHs grow paddy in their farm. It was the prime crop followed by maize and wheat. The average productivity of paddy, maize and wheat were respectively 203.65, 146.18 and 131.21 Kg/ropani. Similarly, maize based cropping pattern with

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intercropping of millet or soyabean during summer season, and followed by wheat during winter season was practiced cropping pattern. The average production of these crops (maize, millet and wheat was 146.54, 100.74 and 96.94 Kg/ropani respectively). 98 % of the HHs considered maize crop as a prime cereals, of which about 93 % included millet as intercrop, considering its equal value in regular food consumption. Rice occupies the second position, in terms of total area grown.

Ø Around 60 % of the HHs prioritized poultry chicks for rearing, followed by 32 % of the HHs interest in vegetable production. For the case of off season vegetables, 140 HHs were interested in producing off season vegetables under plastic house.Similarly other interest of the people included: Improvement in Farm yard manure and cattle shed, goat shed improvement, goat raising, cattle raising, soil nutrient management, promotion of kitchen garden, skill training, fodder crop, legume crops, improved seeds of cereals and irrigation. Likewise, off farm interest of the beneficiaries were observed to support for stitching machine and mason training.

Major Intervention during reporting period: Support Activities at HH level:

Ø Distribution of packaged seeds including 250 g of legume seed (all season beans) and 5 g of bitter gourd seed for kitchen garden to all 425 HHs. Apart from this support, 181 HHs each received the seeds of 10 g cauliflower and 250 g coriander

Ø Distribution of silpaulin and necessary packages (2 Kgs nail, 2 binding ropes, 1 Kg binding wire, 2 cattle urine collection drums each of 50 litre capacity) for production of off-season vegetables, especially tomato for 140 HHs of project VDCs (Tauthali – 60 HHs, Piskar- 80 HHs).

Ø Provided 52 packets (each of 2 g) of srijana variety of tomato seeds and 28 roll – each of 5 meter length - of plastic sheet to prepare nurseries for preparation of seedlings to 140 HHs. The seedlings prepared after 21 days were then distributed to all 140 HHs who have planned to cultivate off season tomato under plastic house.

Ø Distribution of chicks and poultry packages (first lot)

o 8 weeks old, 3,095 poultry chicks distributed to 251 HHs,

o 255 set of drinker and feeder to each of 255 HHs, o 1,000 Kgs of poultry feed (20 bags of 50 kg weight) with average of 4 Kgs feed to each

Household. Ø Distribution of fodder and forage crop seeds and seedlings to 90 HHs.

o 1,800 seedlings of broom grass, o 4,500 seedlings of nepier grass o 5 Kg of epil-epil seed o 5 Kg of soya grass seed

Ø Distribution of 1,200 cardamom seedlings to 13 HHs at Tauthali

Figure 3: Seedlings of tomato at transplanting stage

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Capacity Development and Training Activities to HH level: Ø 167 HHs received 2 days training package on off season vegetable production. 8 events

of training were provided Ø 1 event of 2 days training was provided to 18 HHs on poultry production.

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4.2.4. Reducing the Impact of Poverty on Maternal and Child Health by Improving Food Security and Access to Basic Health Services for 18,000 people in the Karnali Region of Western Nepal

This Project with funding from the DFID (UK Aid) Global Poverty Action Fund has been implemented in 5 VDCs: Maila, Jair and Melcham of Humla, Wai and Kolti of Bajura. The project mainly focused on empowering women farmers and increasing their income level through the interventions in agriculture farming and livestock rearing as well as increasing access of women farmers to micro finance through saving and credit activities. The project is integrated with PHASE community Health project and adult literacy classes. Table 13:Major activities and beneficiaries –June 2016 to April 2017 S.N Activities No.of

Event Total beneficiaries Female

Male

1. Monthly meeting with Agriculture Group 158 1803 1380 2. Monthly meeting with S/C Group 120 1474 9 3. Nursery Observation 373 759 571 4. Counselling Technical Support to farmer 270 670 498 5. Field Visit 321 873 851 Trainings 6. Training on improved farming technique 8 153 32 7. Training on S/C Group 20 257 106 8. Trianing on Soil Fertility Improvement 4 84 46 9. Training on Kitchen Gardening 3 50 21 10. Training on Vegetable Seed Production 14 163 124 11. Training on Animal Husbandary focusing mainly

on improved breeds and fodder management 16 211 122

12. Training on low cost water irrigation(drip/sprinkler)

14 166 113

Material Support 13. Vegetable seed distribution 63 630 315 14. Stationery support 26 597 194 15. Water cane(hajari) 8 89 65 16. Agriculture equipment 0 0 2 17. Irrigation pipe/ water sprinkle 1 0 4 18. Spray tank for home made pesticide 4 0 6 19. Green house/ poly house demo 35 53 42 20. Other livelihood activities 77 460 344

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4.3. Challenges The working VDCs are extremely remote therefore regular and timely communication with project teams in the district as well as VDC is one of the major challenges through out the project period. Similarly, obstruction of roads due to landslides and flood during the rainy season affected the mobility and timely movement of staffs. The flights are also irregular further delaying timely arrival and departure of staffs to working areas.

4.4. SuccessStories Magani, now a self-dependent woman Magani Ghale a 35 year old woman is a resident of Kashigaun V.D.C a remote VDC that was badly affected by earthquake. She is a mother of 3 children. She is basically illiterate as she never got the opportunity to learn to read and write. Magani has a small piece of land, the production from it was sufficient to feed the family for 4-6 months of the year. She and her husband would work as laborers to make ends meet through the remainder of the year. After the earthquake, PHASE Nepal started an integrated project to support the poor and disadvantaged people. The livelihood program was implemented as part of an Integrated Community Development Program. Magani became a member of one of the farmers group that was formed with the facilitation of PHASE Nepal. She received training on seasonal and off season vegetable production and also received seed support for producing vegetable in her land along with plastic sheets for the construction of poly house. The support she received has now enabled her to earn a better livelihood. She has now become a full time agriculture worker working in her own farm. She also received 10 poultry chicks from PHASE Nepal. She reared these, sold 3 chicks earning 7,500/- and 6 chickens are used for egg hatching purpose which provides additional source of income; 1 chicken fed the family during a festival. She consumes vegetable produced in her farm and sells the surplus in the nearby market. The earning and her full time engagement in agriculture have enabled her to have a more secure and better livelihood. She is educating her children in the nearby school. She does not want her children to be illiterate like her. Education for her children may provide better opportunities for her children, she says with confidence. She has been successful to implement her learning of Vegetable Production, Poultry farming, Fruit cultivation, seasonal and off season vegetable production. She is now a capable and self-dependent woman.

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5. CHAPTER5:COMMUNITYEDUCATIONPROGRAMME PHASE Nepal's Community Education Programme is one of the three pillars of PHASE’s integrated community development approach. PHASE Nepal aims to promote access to and quality of education by a variety of interventions in its project areas. The community education program is aligned with UNESCO's "Education for All" 2000-2015 movement and with United Nations Sustainable Development Goal no.4 that focuses on Education (UNSDG4) 2030 which aims to "Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all”. Major Objectives of PHASE Community Education Programme: 1. To provide access to education for the deprived children of remote mountainous villages. 2. To provide literacy and numeracy skills to illiterate adults especially women. 3. To strengthen community schools in remote areas with educational support materials and

capacity building of teachers and school management committee in order to create better learning environment in the schools.

4. To raise awareness of Children’s Rights among students, teachers, School Management Committees and Parents Teachers Associations’ members and other concerned stakeholders through training on child protection and by mobilizing school child clubs.

5. To empower adolescent girls and boys with leadership and communications skills and knowledge regarding Personal Hygiene, Human Trafficking, consequences of Child Marriage, Child Labour, Gender based discrimination; value of school completion and higher studies so as to make them able to mitigate these social issues and work for the better future.

Chart 1 | Goals and Strategies of PHASE Education Programme

5.1. StaffInformationTeachers, education development facilitators and trainer are the front line project staff to undertake the project activities at the community level. Altogether 10 staffs have been working in education projects in this reporting period, 6 of whom are female. Trained teachers support the

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alternative school education. Similarly education development facilitators support the trainer and collect information and conduct feasibility study. Trainer conducts the training. Education officer and the Project Manager develop the training manual and support in training conduction. Project manager provide guidance and support the field staffs in project implementation as well as monitors the overall program and staffs.

5.2. ActivitiesunderEducationProgramme

5.2.1. Education Access Programme PHASE Nepal's one of the top most priority is to provide access to opportunities to everyone in the communities itworks. PHASE has its three specialized programmes designed to promote and ensure community's access to education.

5.2.1.1. WomenLiteracyProgrammePHASE has been providing education access programme to illiterate females with special priority to young and illiterate mothers in some of the remote parts of far western and mid-western part of Nepal. In the year 2016/17 PHASE provided adult literacy classes to 100 women from Kolti and Wai VDCs of Bajura District and 223 women from Ruga, Kotdanda and Fotu VDC of Mugu District. These women were provided daily literacy classes in their own locality based on the latest curriculum of Non Formal Education Centre (NFEC) under Ministry of Education of Government of Nepal. The literacy class are linked with PHASE livelihood programme where the participating women not only learn how to read and write but also the knowledge of improved farming method. The classes are usually run in the evening so as to not disturb the day to day chores of participating women.

Figure 4: Adult Literacy Group in Wai Bajura

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Table 14: Adult literacy classes in year 2016/17 in Mugu and Bajura

VDC / District Participants No. Group 1

Ward No.

Participant No. Group 2

Ward No.

Participants No. Group 3

Ward No.

Participants No. Group 4

Ward No

Kolti / Bajura 25 7 25 8 - - - -

Wai / Bajura 25 1 25 8 - - - -

Ruga/Mugu 25 2 50 8 - - - -

Kotdanda/Mugu 25 2 25 4 - - - -

Fotu/Mugu 25 1 25 2 25 7 23 6

Total 323

5.2.1.2. Flexible Schooling Programme PHASE has been running Alternative School education to the children in remote schools providing trained teachers and learning resources at their doorsteps. Many children in high mountain regions of Nepal are out of school for various reasons including poverty, access to school among others. PHASE works to bring those children back to school. PHASE has been supporting two schools in Chumchet VDC in Gorkha. Chumchetis a remote VDC situated in the mountains of North Gorkha. It takes about 6 days walk from the nearest road head to reach Chumchet.Last year these alternative schools were linked with two mainstream government schools by co-ordinating with District Education Office, Gorkhafor institutionalization and sustainability of the project. Taju Alternative School has been merged with its parent school Siddha Ganesh Basic School. Even after the merger PHASE has been providing teachers and additional supply for the schools. Currently 69 children from the Sherpa community are benefitting from the access to quality primary education from two villagesYarchyo and Taju of Chumchet VDC. In addition to providing all the necessary educational materials for these students, PHASE provided a set of winter clothes to each student in these two schools to cope with winter in the high Himalayas. This project has been successfully handed over to Community Action Nepal (CAN – another NGO working in the area) at the end of this fiscal year. The same model is being supported by the new organization.

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Figure 5: Students of Alternative School in Chumchet, Gorkha

Table 15: Flexible Schooling Programme in Chumchet Gorkha

*Government teacher

SN Name of the School No. of children

No. of teachers

Male Female Total Male Female Total

1 Yarchyo Alt. Primary School 8 12 20 - 2 2 (Merged with Chumling P. School)

2 Taju Alt. Primary School 20 29 49 1* 1 2 (Merged with Siddha Ganesh P. School) Total 28 41 69 1 3 4

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5.2.1.3. Back to school program for out of school children In Nepal especially in the remote rural communities the school dropout rate is very high. Thousands of children are out of school because of several reasons like poverty and social discrimination. The situation further exacerbates because of natural disasters. PHASE works in remote mountainous region which are vulnerable and susceptible to landslides and flood during the rainy season causing damage to homes and schools. The earthquake and subsequent aftershocks have badly affected homes and schools in the area. Many schools are still running in tents. Children are the first to suffer during these disaster and girl children are generally forced to drop out of the school in order to support the family in household chores. In order to ensure continuation of school and alleviate drop out owing to deprivationcaused by social economic and natural factors PHASE provides basic sets of school supplies to the children and provide follow up support. The main objective behind these efforts are to help children continue their school and not lose the existing access to education. With the help of these interventions PHASE also aims to bring back those children back to schools who have already left their schools and are currently helping their hands in earning a living with their parents. In the year 2016/17 PHASE supported 181 students from Humla. PHASE provided school bag, notebooks and stationery. With the support from parents and teachers these children are now back to their school continuing their regular education. These students were identified by PHASE Nepal through intensive survey conducted in the months of May and June 2016. These children are the school dropouts who were unable to bear day to day expenses of school. Although the education is provided free by the government these children were not even able to afford the books and stationery owing to their poor economic status further worsened by social marginalization and caste system.

Figure 6: Deprived children of Humla received educational material to continue their school

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List of Supplies provided to the children in Humla SN Particulars Unit Magnitude 1 Exercise Books Pcs 4560

2 Pens Pcs 4560

3 Pencil Pcs 1140

4 Eraser pcs 380 5 Sharpener pcs 190

6 Bag Pcs 190

Table 16: Details of identified and supported students in Humla

SN VDC Male Female

Dalit

Brahmin/

Chettri

Total Male Female Male Female

1 Melchham 25 18 6 2 19 16 43

2 Jair 22 22 4 3 18 19 44 3 Maila 48 46 15 18 33 28 94 Total 95 86 25 22 70 63 181

5.2.2. School Support Programme To strengthen the quality of community schools, PHASE provides mainly two kinds of support horizontally i.e. first by providing necessary educational materials, second by providing training to the teachers. This approach has been supplementary to each other as it provides necessary skills as well as required materials for quality teaching learning in the schools. Furthermore, PHASE Nepal also provides orientation to School Management Committee to facilitate better governance of community Schools. As part of the school support PHASE provided essential school materials to 4 schools of Rawadolu VDC, Okhaldhunga, 8 schools of Kashigaun and Keraunja VDCs,Gorkha and12 schools of Kolti VDC,Bajura as per the request received from respective School Management Committees. In addition to providing the requested support, PHASE piloted creation of 12 Model classrooms in each of the schools of Kolti, Bajura.

Table 17: List of essential school materials supported in Okhaldunga and Gorkha S.N District Materials supported 1. Okhaldunga White boards, markers, globes, madal, guitar, khaijadi and stationery items like nataraj

pencil, eraser, pen, exercise book, diary, pen, bag, etc. 2. Gorkha Educational materials like whiteboard, board marker, graph board, glove, wall clock,

punching machine,etc sports materials like football, volleyball, skipping rope, drum set, ludo, carem board, madal, ring,etc. and laboratory materials like glass slabs, litmus papers packet, lenses, beakers, conical flask, human skeleton,prisms, pullies, etc.

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I. Sports to Empower Sherpa Girls and Boys PHASE Nepal has successfully piloted a sports project in Rawadolu VDC of Okhaldhunga. The main aim of the project were to:

- Integrate Sherpa children into mainstream school with the help of sports - Mitigate the trauma caused by earthquake among the school going children. - Contribute in improving the health of the school children through sports and education. - Provide equal learning opportunities for girls

II. Sports Teacher support: The project also sponsored a sports teacher in the village and to conduct regular sports activities in the schools and conduct VDC level sports competition. Table 18: List of distributed sports items in Rawadolu, Okhadhunga

SN Items Unit Quantity 1 Volley Ball Net Pieces 8 2 Volley ball Pieces 12 3 Foot Ball Pieces 8 4 Pumps Pieces 8 5 Track Suits Pairs 700 The schools already have skipping ropes donated by some other organization. The sports classes were conducted regularly in the schools and school level events were organized during the weekend. Furthermore, 2 big events were organized in the Village level in the presence of school management committee of all schools and PHASE Nepal representatives where girls and boys from all the four schools took part in different events and competed with each other. The winners of the events were given certificate and medal from PHASE. The sports events consisted of.

1. Boys Volleyball 2. Girls Volleyball 3. Girl/Boys mixed primary level football 4. Relay Race 5. 50 and 100 metre race

5.2.3. Girls Empowerment Programme PHASE Nepal has been running Girls Empowerment project with the financial support from PHASE Austria and Eco Himal focusing on adolescent and teenage girls. The project is implemented in Kolti and Wai VDC of Bajura district with following objectives:

Ø To empower 20 young local females as leaders and facilitators and also as long term sustainable agents of empowering girls.

Ø To educate and support 280 local teenage girls with knowledge on health, leadership, rights, effective communication and problem solving.

Ø To empower adolescent girls from remote mountainous village to be able to speak for themselves and stand for their rights and defend the several ill practices that are biased especially against woman.

Ø To provide need-based support to the participating teenage girls with the help of the project seed fund.

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A four day long training of trainers was conducted by the PHASE Education and Health team to enhance the confidence of the selected 20 facilitators as well as to equip them with training skills, leadership skills, in-depth knowledge about menstrual hygiene and the ways to cope with such issues. 20 facilitator from different villages of Wai VDC were selected. They are currently busy in forming girls group in the schools. They will start conducting empowerment workshops in the schools after completing the girl's group formation work. In short the topics discussed were as follows:

Public speaking and effective communication Facilitation skills Managing menstrual hygiene and coping with the associated social taboos Early age marriage and its consequence Human trafficking Stress resilience Anti bullying Creating the girls effect by forming girls group and work to solve problems Having an aim in life and working on it

The trained facilitators conducted workshop for 14 days. The workshop was conducted in 3 batches and had participation of 272 girls from 4 schools of Kolti VDC. After taking part in the workshops the girls were also given some project works. The girls groups performed the following activities in their communities.

1. Door to door visit to identify issues related to rights of the girls and presentation on the same in the group.

2. Awareness raising for need of girls friendly toilets in schools 3. Girls involvement in sports and access to sports materials in schools. 4. Raising awareness on menstrual hygiene and menstrual isolation in the schools.

The girl's empowerment programme was completed successfully in the Kolti VDC of Bajura with close co-ordination withdistrict education office, local schools and community members. The programmes was ofit's kind was conducted in the village for the first time. Significant learnings and changes in the girls was noticed. The confidence of the girls has been boosted. They are more vocal and open in speaking about their problems. Behaviour and attitude change among the stakeholders viz, teachers, parents and School Management committee was noticed during the project period. Particpants also spoke about being able to resist harmful practices better, such as early marriage and menstrual exclusion. This was clearly noticed during a recent project area visit by DFID country head, DFID health advisor, PHASE Nepal health advisor and PHASE Nepal Executive Director. The participant girls clearly explained aboutbenefit of the programme, their aim in life and also requested to involve boys also in this programme.

5.2.4. Empowering Parents and School Management Committee PHASE team consulted management committee members of four schools and organized an orientation program. The orientation program was focussed primarily on the roles and responsibilities of members of School Management Committee and Parents Teachers Association to encourage and motivate the children in school and at their home. They were also oriented on creating a unbiased and friendly learning environment at home both for son as well as daughter. Reflecting on the current condition and ongoing hardship of the parents, PHASE trainers highlighted on how education can give a bright future to their children. PHASE local girls facilitators also shared their experience.

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A total of 85 parents took part in the PHASE Workshops.These parents shared that it was the first time they have participated in such a program and promised to support their children in getting educated.

5.2.5. Child Rights Programme To ensure rights and protection of the children of its project VDCs, PHASE Nepal runs campaigning and awareness programmes in close coordination and support of school child clubs. 19 Child Rights / child protection trainings were provided to the groups of teachers, parents and the community members in 19 VDCs of Gorkha, Humla and Bajura district this year.

Table 19: Child Right Training District VDC No. of Training

Humla Maila, Melchham, Jair 3 Bajura Rugin, Kolti, Wai, Bichhaiya 4

Gorkha Kashigaun, Keraunja, Chumchet 3 Sindhupalchok Hagam, Fulpingkot 2 Kavre Rayale 1

Mugu Ruga, Kotdanda, Photu,Dhainakot, Natharpu, Hyanglu 6

Total 19

5.2.6. Health Education Programme Health staff of PHASE Nepal provided health education to all the schools in the project VDCs on a regular basis. The health education classes provided a good platform for the children to have face to face discussions and sharing with health workers like Staff Nurse, Axilary Nurse Midwives and Health Assistants. In addition to the regular classes, health staff alsoprovided first aid training to the students and teachers and also performed basic health check-ups of the school students. Table 20: Health Education in the schools of project areas District VDC No. of Schools

Kavre Rayale 5

Sindhupalchok Hagam, Fulpingkot, Baruwa, Bhotang 26

Humla Maila, Melchham, Jair 25 Bajura Rugin,Bichhya, Wai, Kolti 36

Mugu Kotdanda, Hyanglu, Natharpu, Ruga, 35 Photu, Dhainakot Gorkha Manbu, Kashigaun, Keraunja 18

Total 21 VDCs 145

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5.3. TechnicalSupportfrompartnerorganisationsEvery year, PHASE Nepal hosts international expert from Health, Education and other relevant fields to provide on the job coaching to the PHASE staff of respective departments. These visits are facilitated by PHASE Worldwide, UK. The visitors come with the triple objective of supporting donor monitoring, gaining some knowledge and experience themselves as well as and imparting their knowledge and skills to the staff of PHASE Nepal. In Education department we hosted three experienced teachers from the UK namely Ms Helen O’Gorman, Ms Gemma Golds and Ms Kirsty Robertson in the year 2016-17. Table 21: Volunteer's visit in PHASE working areas Main Activity/ Training Placement

Helen O’Gorman Sample classes with the students and a short model training to the English teachers of Araniko Sec. School

PHASE Central Office, Araniko High School

Gemma Golds Interactive classroom activities,

storytelling and phonics PHASE Central Office, Rayale Schools

Kirsty Robertson Effective lesson planning tools, play way method of learning and classroom management

PHASE central Office

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5.4. SuccessStoriesStrengthening School Management Committee for improving quality of education In 2016 PHASE conducted a series of Teacher Training and School Mentorship program in 11 schools in Kolti Village Development Committee (VDC). 58 teachers were trained and 18 outstanding teachers were provided additional training for mentoring their fellow teachers in the schools. The aim of the program is to improve access to and quality of education. PHASE also initiated follow up program of creating model classrooms and also supported in the capacity building of School Management Committee (SMC) for effective school governance. The SMC were trained and oriented as part of their awareness raising and capacity building. One of the core aims of the project was to empower two important bodies of school governance for the betterment of the school, the School Management Committee (SMC) and the Parents Teacher Association (PTA). Through this project, PHASE Nepal helped to organize regular meetings of the PTA and SMC in the schools with the expressed goal of making parents and school officials more aware of their specific roles and responsibilities in the overall management of the school including the quality of instruction. A total of 85 PTA and SMC members from 12 schools of Kolti village received the first orientation and training session from PHASE. As a direct consequence of their participation in these trainings PTA and SMC members become more aware of the powerful and positive role they can play in school management and governance. Before participating in this training, the chairpersons of the school management committees in Kolti, would hardly dare to question school directives that came from the principals as the principals are considered educated and having a higher social status than other community members. After the training, however, these same SMC and PTA members realized their roles and responsibilities in improving the quality of education in the school through their active participation and input in decision making. The PTA and SMC members in the schools we worked with, now appreciate the legal authority and moral responsibility they have with respect to the effective management of the schools. Raju Devkota, SMC member of Chandranath Lower Secondary School said “I felt that school management committee should be more serious about improving the schools, not just relying on the principal to do everything.” These SMCs and PTA will receive a follow up orientation and additional training sessions during the duration of the project period. They were thankful for the continued support PHASE Nepal has been providing to schools to improve the quality of education.

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6. CHAPTER6:RECONSTRUCTIONANDRELIEFPROJECTS The recovery and reconstruction activities have been implemented in 6 districts. Food items, shelter kit, education kit and hygiene kit were provided to the landslide/flood victims of Bajura and Humla. 4,053 flood and landslide victims were benefitted through this program. The other reconstructon and relief activities has been described as below:

6.1. Sanitation Support Project in Sindhupalchok: Under this project, with finanical support from Caritas Germany and Guernsey Overseas Aid Commission, A total of 820 HHs were supported in toilet construction benefitting 4,848 people from Tauthali and Piskar VDC. One Two-roomed School Toilet has been constructed in Seti-Devi School Tauthali VDC. 488 HHs from ward no. 6 to 9 from Tauthali and 1 to 9 ward from PiskarVDC,took part in awareness raising activities on safe sanitation practice and appropriate toilet construction techniques. WASH promotional materials like toilet soap with soap case was provided to 488 households (211 in Tauthali and 277 in Piskar). Similarly note book (3-6 to each student) with message on sanitation awareness such as hand washing techniques was provided to 900 students from 3 different schools. The support for toilet construction work will enable both the VDCs to regain the status of Open Defecation Free VDC. The open defecation practice among the community people has discontinued. Permanent toilets have enabled the community people to use toilet safely.

6.2. Resilient Rehabilitation of trail in highly earthquake affected communities of Gorkha

PHASE Nepal, with support of PIN (People in Need) and DFID (Department for International Development) and in cooperation with Scott Wilson Construction, has started trail rehabilitation project in earthquake affected communities of Gorkha i.e. Manbu, Kashigaun and Kerauja VDCs with a target of rehabilitating approximately 70 km of foot trail, 5 truss bridges and 8 rest areas. The project has been started with objective of local transport development and support to the local economy, through cash for work approach. The project will be implemented from October 2016 till November 2017.

Figure 7: Toilet in Sindhupalchok

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6.2.1. Objectives of the project: Ø Rehabilitation of existing or construction of new trails in Manbu, Kashigaun and Kerauja

VDCs. Ø 69.67 km trail section in total

§ 16.74 km in Manbu § 19.26 km in Kashigaun § 33.67 km in Kerauja

Ø Metallic truss bridges (5) § Manbu: Megar Khola (24 m), Abdi Khola (20 m), Thade Khola (16m) and Kojung

Khola (16 m) § Kerauja: Pangrang Khola (16 m)

Ø Rest stops (8) § 2 in Manbu, § 2 in Kashigaun § 4 in Kerauja

6.2.2. Achievements on labour Registration:

Before implementation of project according to demand of BoQ prepared by Engineers workers were announced for registration and registration was done accordingly. All together there were 605 numbers of workers registered in Kerauja followed by 953 in Manbu and 356 in Kashigaun respectively.

6.2.3. Total number of workers: Among the registered ones, workers were selected on the basis of Vulnerability assessment. There were total 552 workers in Manbu, 273 workers in Kashigaun and 612 in Kerauja respectively. Workers got an opportunity to work multiple times in different sections after completion of sections. Data table below shows that male workers are more than female. Table 22: Total workers involved in construction

VDC Male Female Total Manbu 370 182 552 Kashigaun 207 66 273 Kerauja 346 266 612

953

356

605

TotalRegistra6on

Manbu

Kashigaun

Kerauja

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6.2.4. Target Vs Achievement for trail rehabilitation: Most of Trail has been already completed with rehabilitation and some new sections have been added up and work is on progress. Out of 69.67 km about 81 Percent has been completed. In rest of the trail rehabilitation work is ongoing. Some sections which are very dangerous and required special skill has been postponed for post monsoon rehabilitation. Similarly, Bridges works are ongoing and rest stops have been planned after monsoon. All together 22 meetings have been organized within VDC for different purpose of trail rehabilitation.

16.7419.26

33.67

69.67

81%

76%

84%

81%

72%

74%

76%

78%

80%

82%

84%

86%

0

10

20

30

40

50

60

70

80

Manbu Kashigaun Kerauja Total

Target(km)

Achievement(%)

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6.3. Prefab Health Post construction in Gorkha and Sindhupalchok

Ø With the support from ChayYa and Global Giving, the construction work of both the prefab health posts in Kashigaun and Keraunja (Gorkha) has been completed and handover to the community / government health service will take place early in the coming financial year.

Ø Health post construction in Hagam VDC of Sindhupalchok is ongoing. Foundation work,

metal truss and CGI roofing was completed. Construction of wall, floor and toilets is ongoing.

Ø All health posts will also be provided with furniture and additional equipment to operate

as upgraded birthing centres. Ø The construction is of steel structure with CGI roof and metal truss. All the three health

posts are constructed as per the Type-II design, includes 2 rooms for staff quarter, approved by NRA and Ministry of Health. The building lies under transitional and recovery project which falls under the supervision of Nepal Health sector support program.

Figure 8: Keraunja Health Post Building

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6.4. School reconstruction in Ghurdanda VDC of Syangja PHASE Nepal with the financial assistance of Trusthouse Foundation (via PHASE Worldwide), supported the reconstruction of Ghurdanda Primary school located at Karikot Chandibhanjyang VDC in Syangja. The original school buildings were completely destroyed by April 2015 earthquake. The school has a total of 7 teachers of whom 4 are permanent teachers and 3 are temporary teachers. The total number of children in the school is approximately 130. The type design was approved by National Reconstruction Authority and District Development Committee. The approved type design consists of 2 storey reinforced concrete building with four rooms in each floor and a stair. With the allocated funding four class rooms (ground floor) has been completed and are ready for use. The school management committee managed the construction with technical support provided by PHASE technical staff. The community is still searching for funding to complete the building.

Figure 9: Ghurdanda School

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6.5. Success Story Toilet is used even by poor people Mr. Joglal, a resident of Sipa village in ward-3 of Tauthali VDC belongs to a poor family. His father's profession was to play Shehnai (a traditional musical instrument) in the village and with the passage of time he learnt the art of playing Shehnai from his father. It was the only source of income with which he fed his family but with great difficulty. Leave alone going to school, Joglal was at times unable to buy shoes which he needed as he would roam around village playing Shehnai. When hand to mouth survival is a challenge, people worry about it only ignoring or paying little attention to other things like cleanliness sanitation and education. Mr. Joglal says "Since childhood I defecated in the open. I was used to it. We in the village thought toilets are used by rich and well-off people. Poor people do not have the means to construct toilets in their home nor are they supposed to use it. I would defecate in the open and would do it in different places. Even if people would see me, I would ignore as I was used to it. With the passage of time, the population in the village increased that caused increase in the rate of open defecation in the village. As a result the village started becoming unsanitary. There would be bad odour around. Slowly and gradually we realized and learnt that toilet is used not only by rich and well-off people but by people from all walks of life to maintain cleanliness, hygiene and health. With this realization the need for using toilet for defecation was felt by all in the village. The local government also planned to declare the district as open defecation free. The toilets were constructed and we started using toilets". But the earthquake in April 2015 destroyed everything including our houses and toilets. People again started defecating in the open. When PHASE Nepal came to our village, all the villagers requested the organization to support in the construction of toilet. We were living in temporary shelter and open defecation was making the environment around filthy. PHASE heeded our request and provided us CGI sheets, cement, toilet pan and rod for the construction of toilet. The contribution of the villagers was labour work. After toilet construction the village has become clean once again. We are thankful to PHASE Nepal for their support.

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7. CHAPTER7:STAFFCAPACITYBUILDINGANDMISCELLANEOUS

7.1. Bi-annual Meeting Two bi-annual staff meetings of PHASE Nepal have been organized in October 2016 and April 2017 in Kathmandu. Staff from all the project working districts namely; Kavre, Sindhupalchok, Gorkha, Mugu, Bajura and Humla were present in the meetings. Some of our staff travelled for several days to attend the meetings and present the work they have been doing in remote regions of Nepal. The meetings were also attended by several members of the executive board and all central office staff - around 120 PHASE Nepal staff members and stakeholders gathered at the venues (ABC hall in October and Yechu Party Hall, Nayathimi Bhaktapur in April). The April staff meeting was chaired by Executive Director (ED) of PHASE Nepal. The guests of honor included Chairperson, General Secretary, Advisor and members of PHASE Nepal. ED gave a brief information of PHASE Nepal's history, its growth and vision. Opening speech was given by Chairperson Rajendra Karki. He started his speech by congratulating Executive Director, Dr Jiban Karki on securing PhD degree from Sheffield University in the UK. He informed the participants of the visit of DFID evaluation team to Bajura district and the positive feedback verbally given by the team on the good work of PHASE Nepal in remote villages. The commitment and dedication of field level staff enables the EC and management to bid for new projects. He shared that the efforts of staff at all levels right from village to Kathmandu has helped in the growth of PHASE Nepal. The opening speech was followed by a presentation on PHASE Nepal’s goal, objective, strategy and approach. A presentation on Child Protection, Vulnerable Adult Protection and Social Inclusion was done by PHASE Nepal’s Health Advisor Dr Gerda Pohl. Child protection is integral to PHASE's approach. On the 2nd day project level staff gave presentations of their work in groups by districts and projects.

Figure 10: PHASE Nepal Staff meeting

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7.2. Health Training: Biannual health training was conducted in the PHASE central office in October 2016 and April 2017. In October, a training on midwifery was facilitated by volunteer obstetricians and midwives from the UK; a general health update training was facilitated by volunteer doctors and nurses from the UK and Nepal. Topics of the training included CB-IMNCI, Fracture Management, CPR, Poison Case Management, Peptic Ulcer Disease and practical skills. In April, 8 days contraceptive implant training was also provided to four selected health staff in cooperation with FPAN. 5 days General Training of trainers was also provided to all health staff which was facilitated by Krishna Parajuli. A six day training on Communty Based- Integrated Management of Neonatal and Childhood Illnesses (CB-IMNCI) was organized at Gamgadhi, the district Headquarter of Mugu from 10th Dec to 15th 2016. The training was formally inaugurated by Rajendra Kumr Karki (Chairperson, PHASE Nepal) followed by welcome note from Bhagwati Rana (District Focal Person, Mugu). The training was mainly facilitated by Rajendra Karki, Krishna Khatri (Consultant Trainer) and Nirak Sharma (IMCI Focal Person, DHO, Mugu). Figure 11: Training in PHASE office The Training was mainly intended towards the health workers at the community level (Government and PHASE health staff). The training mainly discussed about the roles and responsibilities of the health workers in helping to reduce the Neonatal Mortality Rate and Under-5 Mortality rate through essential health interventions. Altogether 22 health workers (from Ruga, Kotdanda, Hyanglu, Photu, Dhainakot, Natharpu, Rugin and Bichya) participated in the training. All the participants actively participated in the training.

7.3. Social Mobilization Training: Half day Social Mobilization training was conducted for social mobilizers. Training was facilitated by External facilitator Surya Neupane. Brief orientation on social mobilization was provided to the social mobilizers in PHASE office.

7.4. Livelihood training: Two days training (3rd and 4th May, 2017) on soil fertility management had been conducted in Himalayan College of Agricultural Science and Technology, soil science lab and field for 18 field technician of PHASE-Nepal working in remote areas of Gorkha, Mugu, Humla, Bajura and Sindhupalchok. 6 days Livelihood training was organized from 10th to 15th Dec, 2016 at Mugu Headquarters, Gamgadhi. External trainers were hired. All 5 JTA and 7 SM in the region participated in this training. The training mainly focused on the seed germination test, close poly house and botanical pesticide. All the participants actively participated in the training.

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7.5. Education Training The education staff of PHASE Nepal working in districts are provided trainings bi-annually. The training is provided during the visit of the staff for bi-annual meetings in central office, Kathmandu. Following trainings and capacity building workshops were conducted this fiscal year: Table 23: Capacity Building of PHASE education staff. Training Participants Trainers/ Institution

Model training on English as a second language

English teachers of Araniko Secondary School

Helen O’Gorman Volunteer Trainer, UK

Interactive Classroom Activities, storytelling and phonics

5 education staff members Gemma Golds Volunteer Trainer, UK

Effective lesson planning tools, play way method of learning and classroom management

5 Education staff members Kirsty Robertson Volunteer Trainer, UK

Early Childhood Education

6 Education staff members Early Childhood Education Centre/ECEC

Mathematics and Language development in early childhood

5 Education staff members Early Childhood Education Centre / ECEC

7.6. Scholarship Support for PHASE ANMs to Study Nursing With Support from a UK charity, Doctors for Nepal, PHASE Nepal has recently been able to support selected Auxiliary Nurse Midwives with scholarships for a three year course in nursing, ensuring their professional future. ANMs are selected according to time they have worked in remote areas, performance in the community and personal / family need for support. They are required to pass the entrance exam of their chosen college. In the last financial year, three ANMs who had previously been working in very remote PHASE project areas, namely Binita Rai, Apsara Jirel and Kalika Thakuri, started studying at two different nursing colleges in Kathmandu.

7.7. Visitors from Abroad

7.7.1. GlobeMed at Tufts PHASE Nepal has been partnering with the GlobeMed Chapter at Tufts University, Boston, since 2014. GlobeMed is a US based student organization with the aim to develop leadership in Global Health. GlobeMed Chapters partner with organizations working in health in low income countries, facilitating learning about Global Health Issues in their university and fundraising for the partner organization.

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Each year a “GROW” (“Grass Roots Onsite Work”) team of 3 to 5 students selected from their chapter visit the partner to learn about their work in direct exposure visits. PHASE Nepal first received a visit from a GROW team in May 2014, which was very successful. After the devastating earthquakes in April 2015, the GROW visit had to be cancelled that year, but since 2016 we again welcomed students from Tufts University to spend a few weeks in our project areas. The 2017 team of three visited Baruwa and Bhotang in Sindhupalchok and learned about PHASE’s integrated approach to community development.

7.7.2. Skilled Visitors from PHASE Worldwide Every year PHASE Nepal’s main partner organization, PHASE Worldwide, facilitates the visit of a number of professionals to Nepal. The purpose of these visits is to support project monitoring by PHASE Worldwide, skills transfer for capacity building for PHASE Nepal, and learning and exposure for the visitors themselves. Below is the list of visitors and the various activities and project areas they supported: Table 24: Visitors’ Information S.N Name Tenure Qualification Working Area 1 Helen O’Gorman 17th July to 30th July Teacher Trainer PHASE Nepal office

2 Alberto Gamez 1st August to 30th September

IT and Management PHASE Nepal office

3 Ailene Chan 13th Sept to 30th Sept GP Hagam 4 Jay Lewis 17th Sept to 1st Oct IT expert PHASE Nepal office 5 Howard Cohen 17th Sept to 1st Oct GP Fulpingkot 6 Alex Rees 16th Oct to 23rd Oct obstetrician PHASE Nepal office 7 Michelle Mohajer 16th Oct to 23rd Oct obstetrician PHASE Nepal office 8 Rachel Downs 16th Oct to 23rd Oct midwife PHASE Nepal office 9 Glen Willis 16th Oct to 23rd Oct midwife PHASE Nepal office 10 Ed Mews 19th to 21st October MBBS doctor PHASE Nepal office 11 Amy Carson 19th to 21st October MBBS doctor PHASE Nepal office

12 Gemma Golds 6th October to 1st Dec Teacher trainer PHASE Nepal office, Rayale Schools

13 Madeleine Wells 17th Oct to 6th Dec GP Mugu 14 Paul Arnold 16th Oct to 19th Nov GP Keraunja 15 Liz Alun-Jones 2nd to 19th November GP Kashigaun 16 Anne Tongue 2nd to 19th Nov GP Manbu 17 Chris Remfry 8th to 18th November GP Fulpingkot 18 Sarah Galvin 14th Nov to 1st Dec PWW director PHASE Nepal office, 19 Jane Panikkar 18th to 25th November Gynaecologist NNCTR 20 Sarah Caukwell 18th to 25th November GP colposcopist NNCTR 21 Will Parry-Smith 18th to 25th November Gynaecologist NNCTR 22 Hugh Thomas 5th to 15th December GP Fulpingkot

23 Judith Owens (Ames) 31 Jan to 1st March GP Baruwa, Bhotang

24 Robert Owens 31 Jan to 1st March accountant PWW audit and accounts support

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25 Joe Witney 2nd March to 30th May junior doctor support with clinical guidelines new edition

26 Hannah Corkery 2nd March to 30th May general

volunteer communications and data support

27 Jonny Rae 23rd March to 2nd April GP Kashigaun

28 Tessa Sinclair 23rd March to 2nd April GP Manbu

29 Richard Garlick 23rd March to 21st April GP Hagam, Baruwa, Bhotang

30 Linda Barry 29th March to 6th April GP Rugin, but returned back early

31 Sarah Galvin 29th March to 20th April PWW director PHASE Nepal office, 32 Kirsty Robertson 7th to 14th April teacher trainer support to education team

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7.8. Nisha Tamang Memorial

PHASE staff nurse, Nisha Tamang, was tragically killed on the 8th August 2016 in a helicopter crash in Madhanpur-9, Pakhure, Nuwakot district. Nisha was accompanying a young mother with a serious postpartum infection and her 5 day old baby, who had a fever, with three members of their family, from her work station in Filim Health Post Sirdibas VDC (Gorkha district) to hospital in Kathmandu. The helicopter pilot, Ranjan Limbu, who had worked with our team in many flight missions during the earthquake relief, also perished in the accident, together with the young mother, Preeti

Gurung, her 5 day old son, her parents in law Jitman and Agyani, and another young relative, Laxmi Gurung. Nisha was a loved, respected and skilled member of the PHASE Nepal team. After working as lecturer in a paramedical college she had joined PHASE in February 2016 and had been based in Gorkha, supporting health projects in Chumchet, Chhekampar and Sirdibas. She was committed to improving health in rural communities, demonstrated by her desire to serve patients in remote areas. She and her colleague, Srijana, had spent several days and nights caring for Preeti and her sick baby and the decision to refer to Kathmandu was not taken lightly. – There was a very real risk that Preeti could have died from her infection, as treatment at the health post was not working. That both mother and baby and those trying to save their lives all died on the way to safety is a devastating tragedy which throws into stark relief the realities of living and working in such remote areas of Nepal: There is no feasible alternative to helicopter transport in such a situation during the monsoon: Footpaths are simply not passable, and the next road would be 3 days away even if they were… This is the biggest tragedy that the PHASE team suffered in the history of the organisation, and coming so soon after the devastating earthquakes it was particularly difficult to adjust. To commemorate Nisha’s contribution and ultimate sacrifice, PHASE Nepal started collecting donations for a “Nisha Tamang Memorial Fund”, with the hope that this could evolve into a scholarship fund for needy students from Nisha’s home community and the community she had worked in. A total of around 600,000 NRs was raised, which wasn’t deemed sufficient to run a continuous scholarship project. After discussions with Nisha’s family, the PHASE Nepal board decided to give 80% of the funds raised to Nisha’s family to support her younger brothers’ studies, and 20% to the family of Laxmi Gurung, a young relative of the deceased mother, who had also died in the crash and left a young son behind.

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8. CHAPTER8:COORDINATION,NETWORKINGANDMONITORING

8.1. Support, Monitoring, Partnership & Networking PHASE Nepal has good presence of staff in project areas for different programme components. ANMs, JTAs and teachers/Education facilitators work in direct implementation of health, livelihood and education programme respectively and report each month on activities. For the earthquake recovery and reconstruction programme engineers, overseers and suboverseers have been recruited. These staff are involved in facilitation, social mobilization and implementation as well as monitoring duties in the project areas. PHASE employs seven Health Supervisors (HA/Staff Nurse) in Mugu, Gorkha, Humla, Bajura, Sindhupalchok and Kavre districts for theHealth programme. For Education Development Programme, PHASE has appointed one Education Development Facilitator for Gorkha region to support teachers, teacher training and other education activities. Trained teachers are monitored by mentor teachers in the field and send reports to the Kathmandu office on a regular basis. For the livelihood programme, a supervisor with B.Sc. in agriculture supported project staff and improved reporting and communication with the central office.

Table 25: Support, Monitoring & Networking | July, 2016–June, 2017 Activities Sindhu. Humla Gorkha Kavre Bajura Mugu Total

Public Audits in 4 6 6 2 8 12 38 Field Posts Support by Field 1 1 1 - 1 2 6 Supervisors

Field Visit from 5 2 7 2 3 2 21 Kathmandu

MeetingwithDistrict Government

9 2 5 0 5 6 27

DPAC & Review meeting in District

1 - 1 0 - - 2

Meeting with Donors 10

PHASE Nepal organizes bi-annual Public Audit events in all project villages to inform the community in detail about project activities and financial details carried throughout the year. This year there were 38 public audit events organized in 19 project communities.There were a total of 21 visits made from central office to project areas to monitor, supervise and coordinate with field staff as well as stakeholders. Regular networking meetings were organized with district level government authorities. DPAC (District Project Advisory Committee) meetings have been organized in Gorkha and Sindhupalchok districts. PHASE also regularly takes part in review and progress meetings and workshops organized by district government offices in project districts.

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Table 26: Reporting schedule of PHASE Nepal Report by Report to Subject Period

PHASE Nepal Donors Annual Programme & Budget Annual

PHASE Nepal Donors Progress and Financial Report Quarterly

PHASE Nepal Donors Annual Budget Annual

PHASE Nepal Districts Annual plan and Progress Report Annual

PHASE Nepal SWC Annual plan and Progress Report Annual

PHASE Nepal District Renewal of the organization Annual

PHASE Nepal’s internal reporting takes place on a monthly basis. PHASE field staff either send written report forms to the PHASE office in Kathmandu or they make phone contact with the Kathmandu office and provide monthly reports. Reporting to donors is scheduled according to individual grant agreements. PHASE submits annual reports (project progress and financial) to government agencies every year. Besides, PHASE takes part in yearly and half yearly review meetings of District Development Committee and District Health Office in Gorkha. PHASE has presented project progress reports during the review meetings.

8.2. PHC Workshop PHASE Nepal, with support from the Austrian Development Cooperation and The University of Sheffield and in coordination with the National Health Research Council and Department of Health, organized a workshop on opportunities and challenges in primary health care in rural Nepal. The workshop took place on April 26th 2017 in the meeting hall of NHRC within the Ministry of Health Complex. In the first half, a welcome speech was given by Dr. Jiban Karki, Executive Director of PHASE Nepal in which he welcomed the audience comprising of people from various organizations and backgrounds related to health sector. Mr. Sukhadev Sapkota, the General Secretary of the organization facilitated the event. Dr. Jiban Karki and Mr. Rudra Neupane (Programme Manager PHASE Nepal) presented achievements, challenges and opportunities from PHASE Nepal’s work in health service improvement in remote rural areas. It was followed by the presentations from various representatives working in the area of health. Presentations were followed by a lively Q&A session, which raised questions on the sustainability of health care, the issue of quality and continuity and the challenge to implement policies in remote areas. Figure 12: Discussion on Nutrition Intervention in PHC

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The second half of the day was taken up by small group discussions around the following five themes: 1. Traditional Healers and PHC, 2. Human Resource for PHC, 3. Training and Guidelines for PHC, 4. Nutrition Intervention in PHC, 5. Addressing Non-Communicable Diseases in PHC Most participants agreed that the workshop was of value and that similar workshops should be conducted more often in Nepal, to facilitate learning and sharing of different governmental and nongovernmental organizations.

8.3. External Evaluations:

8.3.1. Evaluation of ICDP by Social Welfare Council (SWC) A progress evaluation of PHASE Nepal’s Integrated Community Development Project in 5 districts was conducted by SWC in October 2016. The study methods were FGD, interviews, observation, discussion and document study. Project proposal, previous annual reports and other admiminstrative and financial documents were also reviewed and observed during evaluation study. The health and education related project activities has directly supported the national plan and policy as it has provided teachers and health staff to the government schools and health posts respectively which has helped to improve theseservices. Infrastructure support for health posts and schools was found sustainable as the infrastructure are owned by government. The report praised PHASE’s work and the evaluator wrote in the summary:“SWC should encourage I/NGOs of Nepal to replicate the Health and Education Model of PHASE Nepal.”

8.3.2. SWC Evaluation of WASH recovery Project In the context of Diakonie Katatrophenhilfe Germany funded WASH Recovery project in Sindhupalchok, a progress evaluation was conducted by SWC. The methodology uesd were documents review, project site observation, interview and discussion with stakeholders and beneficiaries. Community participation, ownership of the drinking water scheme by local people, committed field workers, and treansparency are the key features of the project. The evaluation concluded the project was very effective and relevant.

8.3.3. External Evaluation of UK Aid GPAF Project, Far West Nepal In April / May 2017 an eternal evaluation of the UK Aid funded Integrated Programme in the Far West Bajura district was commissioned by PHASE Worldwide. Two experienced researchers / evaluators spent 3 weeks in the project area and evaluated the data from the final survey.

The final report was still in progress at the time of this annual report, but the following statement gives an impression of the appreciation the evaluators felt for the proojects:

“On the basis of 22 years living in Nepal, working in livelihood and health projects, with a special interest (including 7 years working exclusively) in the Karnali, evaluator Dr Naomi Saville feels that PHASE’s project is the most community-embeded and effective she has seen anywhere in Nepal. She feels that this model of intervention should be taken up by others and replicated and that donors should invest more in projects of this design in future.”

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In mid April the head of DFID Nepal, Gail Marzetti, and the DFID Health Advisor, Nichola Cadge, visited the DFID supported PHASE projects in Bajura (Kolti and Wai). They were accompanied by Executive Director Jiban Karki, Health Advisor Gerda Pohl and project manager Urmila Adhikari and interacted with PHASE staff, government staff, beneficiaries and other community members. As a result of the visit, Gail Marzetti gave PHASE the following written feedback: “ Direct observation and discussions with a number of beneficiaries suggested that the current projects have had a significant positive impact in very remote rural communities. I was particularly impressed with the work they do to support government staff. This is setting up a virtuous cycle, with the government staff in these remote areas feeling supported and empowered and therefore being able to do more and increase their engagement. More local people come and are helped which further encourages the government staff. I was also impressed with the huge support they hold with the local communities. Everyone praised the work of PHASE Nepal, including the local government officials who are usually suspicious of NGO work. We met people who had walked for many hours to attend a PHASE clinic where they feel they receive better services and have access to medicines which are usually not available in the remote areas.”

8.4. Promotions and Marketing PHASE Nepal disseminates its activities in e-newsletters. PHASE Nepal has also published a wall calendar for the Nepali year 2074 (14 April, 2017 – 13 April, 2018). Around 2,000 copies were printed and distributed. This wall calendar contains awarenessraising and advocacy messages in all 6 pages, including including activites of PHASE Nepal in the year. This calendar is designed for publicity of the organization as well as spreading messages among the community to raise health, education and child rights awareness. In addition, 200 T-shirts with the logos of relevant donors and PHASE Nepal have been printed this year and distributed to the staff.

Table 27: PHASE promotional activities

SN Promotional Activities Total Qty.

1. Wall Calendar 2,000

2. PHASE Nepal T-shirt 200

3. e-Newsletter 7

4. Organization profile booklet 500

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