The majority of the households in the rural and largely remote regions of the project area depend on agriculture and daily wage labour. While there are some hospitals and smaller health stations, there is an extreme shortage of well-trained personnel. Access to clean drinking water and sanitary facilities is often limited and there is poor availability to health services. Taken together, it is the perfect breeding ground for neglected tropical diseases such as leprosy or parasitical worms, and as such, several of the communities in the project area are in high-risk zones for NTDs. Moreover, there are unacceptable levels of maternal and newborn mortality in the project area. Among other factors, this is a consequence of the high number of home births (45% in Nepal) and pregnancy complications that go undetected because of a lack of prenatal check-ups. In the period following childbirth, most new mothers must cope without any kind of care services. Alongside, the aforementioned limited access to clean drinking water and sanitary facilities means that there is a high risk of infections among newborns. This is aggravated by the fact that every third pregnant woman on average is affected by worm diseases, which can contribute significantly to pregnancy complications such as severe blood loss.

In children, worm diseases can cause slowed physical and cognitive development and can increase the risk of infections. A further focus of the project is on people with disabilities. Several thousand people in the project area are affected by various kinds of disabilities, including those caused by NTDs. Mobility aids such as wheelchairs or crutches are often simply not available or are inadequate. In addition, people who suffer a disability caused by NTDs often face stigmatisation and ostracism from their communities.

Through cooperation in earlier projects, FAIRMED enjoys the trust of the local authorities and population. In this project area, we have already carried out a multi-year project for the promotion of mother-child health and have gathered a great deal of corresponding knowledge and expertise. We are now combining this with our sixty years of experience in the fight against neglected tropical diseases, which disproportionately affect mothers and newborns. We take a holistic approach to meeting the complex set of challenges that are presented in the project area. On the one hand, we ensure that those people in the remote regions of the project area are also provided with access to health services. Among other measures, this is achieved through the construction of maternity centres and medical stations for simple medical treatments.

In addition, we ensure that all healthcare facilities are sufficiently equipped and we provide personnel with the medical expertise that is necessary for the appropriate treatment of NTDs as well as complications during pregnancy. We also inform people in the communities on how to spot the first signs of neglected tropical diseases and what they can do to support their own health. A further cornerstone of the project is guidance and training for local politicians and supervisors of health facilities. This training is particularly important because of the recent political decentralisation in Nepal, which for the first time sees communities tasked with the independent planning and implementation of health policy activities in their region. The major challenge here is the frequent lack of knowledge required to accomplish this new and challenging task.

The core objective of this project is to ensure that the people in project area receive dependable basic medical care. To this end, the project is pursuing three specific aims that are realised through the following activities, among others:

Improved management of health facilities through targeted support for supervisors

• Training for supervisors of health facilities in the planning and budgeting of their activities.

Training for health workers

• Organisation of training for health facility workers. This measure aims, among others, at enabling health workers to recognise and treat the first signs of NTDs. Moreover, knowledge of personnel on the topic of prenatal and postnatal check-ups is reinforced so that possible complications can be identified at the earliest possible stage.

• Training of mobilisers, who are in turn tasked with training volunteer health workers – one in every village. These volunteers serve as contact points for medical enquiries from the villagers and also lead, coordinate and support mother-father groups.

Improvement and development of basic health services

• Establishment and expansion of maternity centres and outreach clinics, which are established in remote areas where there is a total lack of health facilities. These are equipped with the necessary medical infrastructure to meet the basic needs of the local population.

• Support for communities in the planning and realisation of offers for people with disabilities. For example, it is envisaged to offer physiotherapy in the project area for people suffering from disabilities as a result of neglected tropical diseases.

• Together with the communities, FAIRMED ensures that health facilities have the necessary medication and medical equipment such as laboratory appliances.

Raising public awareness of health issues

• Planning and implementation of various activities to raise awareness and inform the general public. Among other approaches, this is achieved by designing and distributing posters and flyers (without text, as many people in Nepal are unable to read) and by broadcasting radio programs. These measures are aimed at improving the health-promoting behaviour of people in the project area, which also results in increased use of health services in the communities.

• Coordination and organisation of awareness-raising events for the early detection and treatment of NTDs.

All FAIRMED projects are implemented in cooperation with the local official agencies and with the inclusion of the population on the ground. The regional FAIRMED country offices are staffed exclusively by local employees. With this approach, and aided by consistent monitoring, problems can be identified in a timely manner, causes can be analysed, and methods and objectives can be adapted where necessary. The direct integration of health ministers and partner organisations also ensures that projects can be transferred at a later point and continued without the support of FAIRMED.

Direct beneficiaries of the project are a total of 825 health managers and health workers, 19,000 people affected by NTDs (such as leprosy, elephantiasis and worm infections), 40,464 pregnant women, mothers and newborns, 9917 people with disabilities due to NTDs, 1670 voluntary health workers, 320 mothers' groups (20 mothers per group = 6,400 mothers) and 4,800 schoolchildren.