In low-resource settings worldwide, neonatal death continues to be one of the most serious and preventable public health challenges. Neonatal deaths are often linked with the preventable causes such as birthasphyxia, prematurity, low birth weight, infections, and inadequate peripartum care. In Nepal, significant disparities exist in maternal and neonatal health outcomes across geographic regions. Difficult terrain, inadequate health infrastructure, lack of qualified healthcare workers, delayed access to care, and inadequate postnatal follow-up systems are some of the particular difficulties these areas face. Although institutional delivery rates have increased nationally, the quality and readiness of health facilities to provide essential maternal and newborn care are still lacking, particularly in rural and hard-to-reach areas.

Global Envirotech Initiative Asia (GEI Asia) conducted a baseline, pre-intervention assessment in Achham district, Nepal, between September and December 2023. The assessment included peripartum surveys among women who had given birth in the previous three years and health facility assessments of birthing centers using standardized questionnaires and checklists adapted from the Government of Nepal survey tools.

Puja, a 22-year-old woman from a remote ward in Achham, went into labor late one evening during the monsoon season. The nearest birthing center was more than 90 minutes away on foot. With no transportation available, Puja and her mother-in-law arrived at the birthing center after nearly two hours. Their neighbors helped to carry Puja on a stretcher as she wasn’t able to walk. At the birthing center, a trained health worker assisted her delivery. Her baby boy did not cry immediately, so the health worker attempted stimulation, but the facility lacked a functional neonatal bag and mask and there was no oxygen supply. The health facility had no infant warmer as well. Somehow baby survived that day, the next day puja and her baby boy were discharged from the health facility. In the week following delivery, no health worker visited her home. The baby boy struggled with feeding and appeared lethargic. By the fifth day, he developed breathing difficulties. And the baby died on the sixth day of life.

Puja's story tells that getting to a health facility on time is not only sufficient if high-quality care is still lacking. Without essential equipment and early postnatal follow-up, preventable neonatal deaths continue to occur. Stories like Puja's can end with survival rather than loss by improving facility preparedness and providing prompt postnatal care.

According to the findings, a total of 530 recently delivered women reporting 1,157 pregnancies and 14 health facilities across 10 municipalities were included in the assessment. Although institutional delivery rates were high, with 98% of women delivering in a health facility and 82% attended by a trained provider, significant access and quality gaps remained. The majority of women (82%) gave birth at birthing centers, yet 37% said it took them more than 90 minutes to get there, indicating ongoing geographic obstacles. Only 43% of hospitals had neonatal bag-and-mask resuscitation equipment, one had oxygen, and only half had infant warmers, indicating a lack of facility preparedness for neonatal care. Leaking roofs (28%), cracked walls or windows (42%), intermittent electricity (93%), and a lack of running water in 30% of buildings were among the common infrastructure issues. 33.6% of women reported having trouble getting prenatal services, and 81% did not receive a visit from a health professional within a week of giving birth, indicating that access to mother care remained poor. Half of the 72 recorded infant deaths (6%) were during the neonatal stage, highlighting serious deficiencies in early postnatal and newborn care.

Despite increasing institutional delivery rates, this baseline study reveals significant inadequacies in the provision of maternity and newborn healthcare services in the Achham district. Key concerns include increasing the availability of trained birth attendants, expanding access to high-quality prenatal and postnatal care, and modernizing the infrastructure and necessary equipment of birthing centers. Reducing avoidable neonatal deaths requires addressing low birth weight, guaranteeing prompt postnatal home visits, and enhancing referral preparedness. Global Envirotech Initiative Asia (GEI Asia) has been instrumental in strengthening maternal and child health in Achham district through its leadership in planning, implementing, and ensuring the quality of the baseline assessment. By producing evidence-based insights, GEI Asia supports community-level prenatal and postnatal care as well as focused treatments and facility upgrades, ultimately improving health outcomes for both mother and child.

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