Project Title: Train Local Youths as Healthcare Workers and Deploy Them in Their Own Communities to Meet Increased Demand for Healthcare Services in their Communities
Location: Rolpa District, Nepal
This research addresses two developmental problems with a single program: provide highly demanded healthcare services in the areas of urgent need and solve high unemployment rate among youth population in those same areas. This research is conducted in Rolpa district in Nepal which is one of the most deprived regions in a country already being listed under Least Developed Countries in the world, Nepal. This district is also notoriously famous for the birthplace of Maoist insurgency that paralyzed the entire country for nearly 10 years from 1996 to 2006, which is believed to be an outcome of increased youth unemployment and acute poverty that crippled the region for many years.
Rolpa district is situated in Mid-western Region which is remote and stands low in all development indicators. As per UNDP’s Nepal Human Development Report 2014, for example, the district is registered with HDI value as 0.395, number of people not expected to survive to age 40 as 10.8 percent, and number of children under age five who are malnourished as 51.3 percent, which are amongst the worst values as compared to national average. According to another report by United Nations Field Co-operation Office (UNFCO), Rolpa has one district hospital, two primary health centers, 9 health posts, and 40 sub-health posts, and as claimed by the report these numbers are acutely insufficient to cover health needs of district’s 224,506 population because of the geographic remoteness of many settlements. A 29% of women aged between 15 and 49 years of age gave birth in the preceding two years of report receiving no ante-natal care at all. Only one in four births is assisted by a skilled birth attendant. So far as employment situation is concerned, on the other hand, many young men and women seek opportunities abroad as the employment opportunities in the district are very limited. According to Nepal’s 2011 Census, 23,597 people, or nearly 11% of the district’s population were absent abroad from Rolpa district seeking employment opportunities as migrant workers. Many villages now are deserted with young population due to this trend.
It is important to address this challenge because many families in remote areas in the district are deprived of basic healthcare needs on one hand and youth in those communities are mostly unemployed or forced to leave their home in search of job in other parts of the country or abroad. On the other side, frequent turnover and unfilled positions for healthcare workers appointed by the government in distant health posts are among the main challenges in extending health services in those areas. Besides, the medicines even for basic first-aid treatments are not readily available leading to the prevalence of higher mortality and morbidity rates. This research is intended to identify whether the healthcare workers trained from within the communities will produce better outcomes in improving these indicators. We believe that youth are incredible source of energy, creativity and inspiration and deploying such individuals will help mitigate the problem that their communities are facing.
The program has following major objectives:
• Identify whether deploying healthcare workers from within the communities will solve the problem of acute shortage of healthcare workers in remote areas.
• Mitigate prevailing high unemployment problem among youth in those communities and employ them to serve their own communities instead of having them left the community in search for jobs elsewhere.
To achieve these goals, we conduct randomized control trial experiments with 10 village councils in the district as treatment groups and 10 other village councils as control groups. We will then select 10 youths, preferably recent high school graduates if available, from each of village councils through participatory approach with community members. Then they will be sent for training for basic healthcare services and then deployed to their own communities after the training is completed.
The program will achieve the following outcomes:
• Production of 10 trained healthcare workers from deprived communities in Rolpa district.
• Provision of basic healthcare services to most needy families in their communities.
• Increased public awareness in the project areas about sanitation and potential health hazards owing to poor health conditions.
• Policy recommendations to the government for possible extension of the program to other communities when it produces positive outcomes.
Summary of Randomized Control Trial Research Design