By Tairu Nesha Khatun and Saraswati Upadhaya, Nepal CRS Company, an implementing partner for field level activities for MOMENTUM Private Healthcare Delivery in Nepal

Pradeep Ale Magar, age 26, and his wife Soniya Pulame Ale Magar, age 24, are certified Community Medicine Assistants who run the Road City Healthcare Hospital which was founded in 1998 as a pharmacy by Pradeep’s father. The hospital is one of 105 private sector health facilities and pharmacies that has partnered with MOMENTUM Private Healthcare Delivery in Nepal. It is located on the East-West highway in a small-town called Harion, in Madhesh Province.

Harion is bustling on Mondays and Thursdays when the local farmers’ market, or haat, is held, and market days are when the hospital is at its busiest. Given its strategic location and steady flow of clients, Pradeep and Soniya were always looking for ways to improve their facility and the quality of their services. This prompted them to partner with MOMENTUM in Nepal, which is providing support to private healthcare providers and facilities to strengthen delivery of quality family planning (FP) services. The private sector is an important source of health services in Nepal, including family planning where one of four modern contraceptive users rely on the private sector for their contraceptive methods.

Strengthening Technical and Business Capacity

In partnering with MOMENTUM, Pradeep and Soniya attended training sessions to strengthen their capacity to deliver high quality family planning services to adolescents and young people. MOMENTUM, in collaboration with the National and Provincial Health Training Centers, delivered training focused on adolescent sexual reproductive health (ASRH), and provision of a broad range of contraceptive methods including injectables. In addition, MOMENTUM provided training on Values Clarification and Attitude Transformation (VCAT). The project aimed to support private providers and health facility owners to examine and transform their attitudes around sexual and reproductive health for young people, especially about how to offer high quality FP services in a respectful and dignified manner for this population, regardless of age and marital status. The VCAT training helped owners and providers to use empathy and purposeful reflection to consider how their values and attitudes may affect client service delivery while offering techniques to support contraceptive use by unmarried clients and adolescents.

Aligned with USAID’s Policy for Private Sector Engagement, MOMENTUM is also working with private sector providers like Pradeep and Soniya to support the sustainability of high quality, person-centered family planning services through the enhancement of business skills. During regular engagements with providers and owners, MOMENTUM staff emphasize the linkages between client experience, quality of service, customer loyalty, and business growth so that providers and owners can prioritize client experience and quality of care when they make managerial decisions and business plans. The business skills training provided by MOMENTUM equips owners with tools and skills to track their income to obtain a clear picture of profit and loss, set business goals, and envision five-year business plans based on client needs, improving client experiences, and quality of care. The training also equips owners with skills to initiate demand generation for quality FP services.

Applying Lessons Learned

Ensuring Confidentiality and Privacy through Better Counseling

Soniya and Pradeep say a key lesson learned was that providing quality services and focusing on client satisfaction are central to a successful business. During MOMENTUM’s initial assessments with their hospital, the threshold for quality FP services was not met. The assessments included an evaluation of holistic counseling, availability of a trained provider, confidentiality, and privacy of clients. Soniya and Pradeep decided to set up a counseling room to maintain the privacy and confidentiality of FP clients.

They worked on applying the knowledge and skills learned during training to provide quality counseling so young clients could make informed choices on the FP methods that are right for them. Soniya and Pradeep quickly realized how the techniques they used to improve quality of FP care were applicable to all other services. “We have now worked toward providing detailed counseling and respectful behavior across all our services,” shared Soniya. The project also supported them to record FP client data daily and report monthly to the national system. The couple embraced the habit of maintaining a daybook tracking other activities at the hospital, such as pharmacy sales, the number of clients using investigative services like x-ray, and the number of clients in the outpatient department, among others. Monitoring these activities has helped the hospital plan for its needs and has supported a better functioning facility.  With continued supportive supervision from MOMENTUM, since June 2022 the hospital consistently achieved scores between 85 to 100 percent in monthly quality assessments conducted by project staff to review issues including quality of counselling, infection prevention, privacy and confidentiality, and stock of FP commodities. Between June 2022 to May 2023, a total of 3,002 clients purchased short-acting contraceptives, of which 16% (447) were adolescents and 51% (1,521) were young people. “I feel high quality services is important. If we provide quality services from our hospital to every client, that helps to increase client satisfaction,” Soniya reflects.

Expanding the Reach of Health Services

Applying lessons learned from MOMENTUM about the importance of promoting their services, the couple organized a one-and-a-half-hour session with 40 students on ASRH at the nearby Chatur Bhujeshwar Janta Secondary School. The school management was pleased with Pradeep and Soniya for providing relevant services and well executed orientations. They signed a commercial contract with Naya Road Hospital to provide monthly voluntary health checkups for students on school premises as well as need-based services and counseling. These health checkups included general health screening, prescription refills, referrals, and counseling on issues of reproductive health, as needed. By March 2023, the couple completed two monthly checkup sessions at the school, attended by an average of 35-40 students and school staff per month.

New Infrastructure to Meet Needs

Despite several improvements, the couple knew that one more drastic change was needed. As part of the business vision exercise conducted during the MOMENTUM-supported training, Soniya and Pradeep expressed their desire to provide a better physical environment for clients to receive high quality services. The couple determined new infrastructure was needed; they decided to move their facility to a more spacious building. “The building is bigger and has more space to expand our services. The new building also has clean functional toilets and 24-hour water supply, both of which were a problem in the old site,” explained Pradeep. The more spacious new site allows counseling, outpatient department and inpatient wards, and other services in separate rooms to better serve their clients. Further, the couple ensured hot and cold drinking water and internet were available for all clients at the new site.

The changes made by Pradeep and Soniya are improving their business but, most importantly, has helped them recognize and prioritize the importance of ASRH services for adolescents and youth. “Working with MOMENTUM, we have been able to improve the quality of our services, we understand how providing respectful services to adolescents and young people can help improve quality of service and help our business grow. We even have a business strategy for our hospital now because of the business training and we have already achieved the small wins we had set toward that bigger goal – growing the scale of how we do business,” Pradeep said. They are confident that now they have the vision and strategy to grow their business sustainably with both the client and quality of care at the center of their approach.

“If we provide quality services from our hospital, that helps to increase client flow and client satisfaction. So, quality services and business are directly connected. In the same way, client experience is equally important for business which is why we have added facilities like internet and hot and cold water for clients. And we are also expanding services and adding equipment based on what clients have been requesting. What I have learned is we have to grow based on quality and client needs,” Soniya shared.

As of August 2023, MOMENTUM has enhanced the technical capacity of 710 private providers in Nepal like Soniya and Pradeep and has helped 103 private sites improve their business acumen and demand generation skills, fostering in turn the sustainability of quality health services. MOMENTUM is scaling up this private sector FP approach to more than 800 additional private sector health facilities and pharmacies across 64 municipalities in six provinces so that adolescents and youth receive high-quality FP services and private sector facility owners and providers have what they need to continue providing such services.