Shishir Dahal (EV from Nepal)

We talked a lot about maternal health, child health, HIV, TB and malaria in the last decade. Millions of dollars were poured into the health system and thousands of health workers were mobilized. With the combined efforts of ministries, international donor agencies, NGOs and INGOs, we succeeded in achieving significant improvement in reducing maternal and childhood mortality and containing many diseases like HIV. It was a beautiful time when hundreds of local NGOs working in the field of the health sector flourished all over the country. Thousands of people got jobs. At the time of the civil war in my country, health became an industry. But with significant improvement in MDG goals their charm started fading. Nepal became less attractive for donors. Hundreds of NGOs, their workers, INGOs and their county directors were on the verge of losing their jobs.

The whole system was searching for a new glamorous health issue to tackle. Suddenly we found one. One in every 10 adult females in Nepal have their womb coming out through their vagina, i.e. utero-vaginal prolapse (Bodner-Adler et al. 2007). A huge burden. Some are very quick in jumping to the conclusion that with the level of human resources we have in Nepal, it will take 60 years to treat existent cases even when working 12 hours a day.
These new findings resonated widely, however. Nepal had found a new MDG+ goal, UV prolapse.

UV prolapse in Nepal is something like HIV for Africa. Let me explain why this should be a fancy issue: it involves women, a vulnerable group; also, it is accompanied by stigma and social exclusion just like HIV. Hesitation and embarrassment to seek medical attention for their condition often leads women to live with this terrible condition for years. In spite of all this, I fear UVP will never be an MDG+ aim. It won’t be addressed by global initiatives because priorities are set in Geneva, New York and Brussels.

Back home in Nepal a poor, stigmatized woman with her pelvic organs in her vagina probably wishes she had HIV.

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4 Responses to Nursing the wombs of poor women – a neglected priority

  1. Eleanor Namusoke Magongo says:

    Shishir, this is a serious problem that you have in Nepal! A neglected priority indeed! How many children per woman on average do the women in Nepal have? I agree with you Ono. It would be great to have consultative processes between donors and the Minisitries of Health(MOH), with the MOH also consulting from right down to the regions, districts. And then the donors & MoH sit together, and the donors asks, May i please have a list of the top three or five priority health needs in this particular country. And then the MOH hands over the lists , the donor looks through. And agrees to fund the top three or four. Instead of the approach, we have so many millions of dollars to reduce a disease X and we are looking for an organization that can ably implement the project in this country.

  2. David Hercot says:

    Dear Shishir, crisp and sharp. Thank you for pointing to those challenges. For the women suffering of this condition and the health systems tensions you witness in Nepal now that, as you imply, donor are turning their back from a success story. Job done seems to be the message. But you rightly point that many problems remain, many conditions are not adressed by current health system capacity. More work needs to be done. 2015 is not the end of the effort it’s just a milestone on the never ending road to UHC.

  3. Onoriode Ezire says:

    This is a great piece re-emphasizing the need to domesticate global goals in terms of issues, target and resources

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