A one year Certificate programme for health assistants in Remote Emergency Primary Care Services in Nepal (Cert.REPSIN)
See the 12 modules below.
It is now recognized that due to Nepal’s large rural population and its distribution over both mountainous and plain regions, access to emergency care and the quality of any such care remain significant challenges faced by the Nepalese healthcare system (Pandey, 2017). After the 2015 earthquake in Nepal where thousands of lives were lost, it was apparent that there was a lack of an Emergency Strategy and there are still currently no guidelines for the management of emergency, trauma or disaster preparedness set out by the Ministry of Health (Pandey, 2016). With a population of 28 million, Nepal has 743 hospitals including 102 public and 641 private hospitals. There are an additional 4000 primary healthcare centres (PHCC) Health Posts (HP) and Sub Health Posts (SHP) reaching into the rural areas (Pandey, 2016). The Health Posts are funded by the government and Health Assistants work in HP after receiving 2 years of general health care training. There are currently no continuous professional development updates and no core teaching in Emergency Medicine practice in the two year training programme for Health Assistants positioned in Rural Health Posts.
The World Health Organisation has a vision for Universal Health Coverage (UHC) for all citizens across the globe and for individuals to have equitable access to a skilled and motivated health worker within a performing health system by 2030 (WHO, 2013, 2016).
UHC provides access to essential health services and safe, effective and affordable essential medicines and vaccines with protection from financial risk. Every year 100 million people are pushed into poverty globally and 150 million people suffer financial catastrophe because of out of pocket expenditure on health services (WHO, 2010, 2016). While this definition covers ‘the full spectrum’ of essential, quality, health services, from health promotion to prevention, treatment, rehabilitation and palliative care, no specific mention is made of emergency care services.
REPSIN is part of the strategy to support people living in rural and remote communities in Nepal , have access to life-saving health care in the event of an accident or other emergency.
Achieving UHC is challenging as it can only be delivered if there is a competent health workforce. Yet there is a worldwide decline in the professional workforce as demand for healthcare outstrips the capacity of current professional body numbers and this is a growing trend. The greatest challenge to people living in remote locations is the accessibility of quality healthcare, particularly in the event of an emergency, as the hospitals and support services are predominantly found in cities. Globally there has been an active and deliberate switch to achieving UHC by developing an assistant health workforce to become competent in a role that will impact directly on improving healthcare of people in the poorest and remotest countries. In Nepal, there is some excellent evidence of the way community health workers can be trained to follow protocols to identify and treat infections in neonates (Khanl et al, 2011). The authors found that from 11,457 live births during 2005-2007, 1,526 (13.3%) of possible severe bacterial infection was identified and treated by the community health workers. There has also been increased immunization coverage across Nepal. In 2001 children of non-educated mothers were four times more likely not to be fully immunized and in 2014 this had reduced to one and a half times this rate. The improved coverage can be attributed to the concentrated efforts of the Nepalese government with NGOs to focus on hard to reach and disadvantaged communities such as Itahari. Targeted communication was a key strategy through its 52,000 female community health workers (Ashish et al, 2017)
The report ‘A Universal Truth: no health without a workforce’ (WHO 2014) argues that there is a need to move away from piecemeal approaches and short term solutions towards long term action backed up by political commitment and adequate investments. This will lead to transformative changes required to attain sustainable results in developing the health workforce. The goal of Universal Health Coverage requires a “paradigm shift”, going beyond a discussion on shortages, to focusing more on:
– Accessibility
– Acceptability
– Quality
– Productivity
with Equity at the centre (WHO, 2014)
For further information contact Dr Martha Zuluaga Quintero maluzuquin@gmail.com