Mobility and Health in Nepal: an update
2007-10-05
In Nepal three research projects are participating in the networked research programme on Mobility and Health. Practical Action has been assessing the health and socio-economic impacts of Intermediate Means of Transport (IMTs), the SDC-funded District Road Support Programme is assessing the effects of restricted access in remote and mountainous areas and the Helvetas-affiliated Trail Bridge Support Unit (TBSU) is researching the impact of transport interventions on health-related issues for marginalised groups. In a recent visit to Nepal, IFRTD's Regional Coordinator for Asia, Ranjith de Silva visited all sites to experience in person what some of the issues are.
Ranjith first visited an area where tuins are used. These are IMTs that have been developed to cross rivers. The tuin helps villagers to cross the river in order to get to the highway close by. Before the tuin the villagers had to walk for an hour to cross the river at another point in order to get to the highway. As a result of the tuin there has been a significant development in agriculture, and marketing of farm produce. The number of school going children has increased by about 70%. Access to health care has been improved dramatically as people now spend only five minutes to get to the highway head, where they can easily get fast-moving transport. This means that pregnant women can now regularly attend clinics in neighbouring towns to receive pre-natal, delivery and post-natal care.
The DRSP programme works primarily through the District authorities and local communities in Nepal. A visit was organised to Dolakha District where the Mobility and Health research field work has been carried out. This vast area has two transport corridors. The research team led by Binjwala Shrestha has been walking and climbing a lot and actually lived in the villages during the field work. The programme has constructed about 30 kilometers of road enabling public transport services to operate. There are health centres and hospitals alongside the road but still communities from distant villages have to walk.
However, accessibility to the hospitals has improved since the construction of the road network and the operation of transport services. Many women, during their pregnancies, now attend clinics. In addition skill development programmes for Birth Attendants and Mid-wives have increased in number and attendance.
The last programme that was visited is the TBSU a local affiliate of Helvetas Nepal. The site that was visited is about four hours driving from Kathmandu towards the North West of the country. The roads off the main highway and the linked roads (earthen roads) -up to a bridge which was under construction- all have transport services operating including big buses. However, a bus journey on a muddy earthen road can be very bumpy and uncomfortable. This is the main reason why pregnant mothers still prefer to walk.
There is a local health centre (which will be accessible by bus once the bridge construction is completed) with some para-medical staff and nurses. After this health centre was opened, it was reported that the influx of patients and in particular pregnant women increased. The transport services available has provided local communities with the option of getting access to the district hospital and as well as to hospitals in Kathmandu. Whether this is also feasible for rural communities especially in terms of costs remains a question. This and other research findings will highlight the overall benefits (especially those related to health) gained by rural communities through the construction of trail bridges.
