CARE Nepal, Ministry of Health and Population, Social Welfare Council and local NGO partners are jointly implementing the Community Responsive Antenatal, Delivery and Life Essential Support for Mothers and Newborns (known as the CRADLE Support Project) in Doti and Kailali districts of Far West Nepal. This is a four year project funded by United States Agency for International Development (USAID). The project aims to bring sustained improvement in maternal and neonatal health in the project district.

CARE Nepal has applied the Child Survival Sustainability Assessment (CSSA) framework as the central planning and design tool for this program, actually using it from the start of program planning and proposal development. The project is one of the first attempts to use CSSA to design a program during the proposal phase. The project used a modified version of the six-step CSSA process to develop a results framework that incorporates CSSA’s three dimensions (Health and Health Services; Organizational; Community and Social Ecological) and six components in order to address sustainable improvements in maternal and neonatal health.

The goal/strategic objective and results for the project are as follows:
Strategic Objective: Sustained improvements in maternal & neonatal (MN) health in the districts of Doti and Kailali

CRADLE Innovations
This project is an innovative project which integrates multiple innovation for sustained improvement in maternal and neonatal health in the project district. The project targets for:
• Community-based management of maternal and neonatal illness;
• Engagement of mothers-in-law as a special target group to improve maternal and newborn care
• Community-based pregnancy outcomes recordkeeping.
• Use of CSSA as the principle approach and framework for program planning and monitoring;
• Utilization of Demand Data and Information Use (DDIU) framework for decision making;
• Study misoprostol use for prevention of post-partum hemorrhage and logistic supply issues in a hill district (Doti)
• Use of local funding mechanism for financial sustainability.

The project will work with the Child Health Division and Family Health Division of Ministry of Health and Population to pilot the national comprehensive neonatal health care package. The project will also apply, adapt and build upon new and promising approaches from India (especially learning from SEARCH at Gadchorilli) and Nepal (especially learning from MINI, MIRA, SNL and CB-MNC projects) for reducing neonatal and maternal mortality. In addition, CARE has selected to apply these techniques in both the terai (plains) and mid-hill zones of Nepal.

Technical interventions of the project include: immunization (5%); nutrition (10%); HIV (5%); pneumonia case management (5%); control of diarrheal disease (5%); and maternal and newborn care (70%). In addition to the strong focus on mothers and newborns, some follow-up and complimentary CB-IMCI support will be provided in the Doti district. This is also important given that the MOHP believes any new approach to maternal-neonatal heath will ultimately be incorporated into CB-IMCI.

Project Beneficiary
CARE has selected the districts of Kailali and Doti in the FWR of the country due to a high level of unmet needs and limited external agency support. Both districts are ranked in or near the bottom third of all 75 Nepali districts, according to the Human Development Index and Gender Development Index. Infant mortality in the two districts is 25% higher than the national average. Kailali is mostly terai but over 40% of its population is considered poor and “marginalized”. Doti is completely within the mid-hill zone and suffers from impoverishment and isolation. The program will cover approximately 502 villages and 3 municipalities. The project works with two District (Public) Health Offices, 97 health facilities and 1850 Female Community Health Volunteers. Project works with two local NGO partners to carryout activities especially under Dimension III : Community and Social Ecological.

Total and beneficiary populations for the two districts are as follows: