In Nepal, we collaborate with Possible, a non-profit which conducts implementation research to test solutions to rural health care delivery challenges. Possible has worked in Nepal for more than ten years, in partnership with the local health care delivery organization, Nyaya Health Nepal.
Nepal is one of the poorest nations in the world. Its population is also approximately 80 percent rural, which only compounds the challenges of accessing health care services. The Institute works in two of the most remote and resource-constrained areas of the country. The hilly area of Achham has limited resources and infrastructure; in addition, it was devastated by the country’s 10-year civil conflict from 2006 to 2016. The second region where Possible conducts research, Dolakha, lost thousands of residents, 90 percent of its housing, and almost all of its health care facilities in the earthquakes of 2015. In both areas, people often travel hours if not days to reach a health care facility.
We currently operate three implementation research projects in these areas. Each project focuses on developing and testing effective approaches to health care provision. In each project, Nyaya Health Nepal provides extensive much-needed clinical care.
Maternal and Child Health
The clinical component of this program identifies all married women of childbearing age (15 to 49), monitors their health and pregnancy status, and discusses family planning methods. It monitors pregnant women up to one-year post-partum as well as children up to age two. The community health workers routinely monitor women and children’s health status, screen for high risk conditions, and counsel parents about maternal and child health. The goal of the study, Integrated Reproductive Maternal Newborn Child Healthcare Delivery, is to improve the sustainable adoption of effective, generalizable, and evidenced-based interventions.
HIV/AIDS has often been introduced to Nepal when men travel outside the country for work and bring the disease home to their wives and children. Nepal has a high percentage of youth living with AIDS; they often have difficulty engaging with treatment, which leads to poorer outcomes than among adult AIDS patients. This implementation research study focuses on youth ages 15 to 24. Community health workers use motivational interviewing, a counseling approach that focuses on internal motivation to help change behavior. We are developing a mobile app, Community-based mHealth Motivational Interviewing Tool for HIV positive youth (COMMIT+) to help patients remain engaged in care. Our research goal is to enhance and improve the mobile health tool.
Both regions have seen extreme poverty and devastation, leading to a significant burden of depression and post-traumatic stress disorder. The patient-care component of this implementation research study involves enabling community health workers to use motivational interviewing, the same internal motivation approach we are using in the HIV/AIDS program. It, too, involves development of a mobile app to facilitate care. The app is called the Community-based mHealth Motivational Interviewing Tool for Depression (COMMIT-D).
We work with the Icahn School of Medicine at Mount Sinai’s Department of Medical Education to host scholars in Nepal. The medical school’s Dean’s Scholar in Global Health spent 2017-2018 in Nepal and co-authored four publications. In 2019, a summer research fellow helped to develop a protocol around assessing household expenditures and financial risk protections. In addition, we educate researchers on site through in-person workshops, online lectures, and mentored research in mental health, manuscript writing, and the ethical conduct of research.