In Dolpa district in the Kernali Zone of Nepal, the best information we have suggests a maternal mortality rate as high as 10%, neonatal mortality rate as high as 20%, and infant mortality rate as high as 33%. These are among the worst maternal and child mortality rates in the world.
There is just one doctor and one skilled birth attendant (SBA) in Dolpa, at the district hospital in Dunai. This hospital is located 4 hours from the nearest village cluster (or VDC), and 7 days from the farthest VDC. Last year, the hospital received just 100 referrals for institutional deliveries and provided antenatal care for less than 300 pregnancies.
Reporting rates for health information in Dolpa are affected by disconnected geographies, with 34% of outreach clinics and 29% of FCHVs reporting to the district health office. Based on the information that is available at the district level, iron compliance for mothers stands at 28%, only 32% of mothers receive post-partum vitamin A, and the hospital experiences a drop in ANC visits from 71% of pregnancies for visit one to 35% for visit number four. 21% of the births recorded at the district level are attended by SBAs, and less than 1/4 of mothers are visited at all after giving birth.
The current maternal and child health information system implemented in Baglung district is focused on data collection and is not actionable for short- or medium-term decisions. Female community health volunteers (FCHVs) create and collect paper pregnancy reports for 45 days, then walk their stack of paper to the nearest health post. Every 6 months, OHW staff collect data from the health posts, then enter data into excel spreadsheets. In order to support the FCHVs, health post staff, and district and regional level healthcare providers, information must move faster.