MOMENTUM PRIVATE HEALTHCARE DELIVERY

Nepal CRS Company implemented the MOMENTUM Private Healthcare Delivery (MPHD) project in two provinces of Nepal from May 2021 to January 2025. The project was part of the broader suite of innovative awards under the MOMENTUM initiative, funded by the U.S. Agency for International Development (USAID), aimed at holistically improving maternal, newborn, and child health services, voluntary family planning, and reproductive healthcare (MNCH/FP/RH) in partner countries worldwide. The MPHD project supported the expansion of public–private partnerships to strengthen the enabling environment for MNCH/FP/RH in alignment with the overall objectives of the MOMENTUM suite of awards.

93 SDPs engaged in PY1-2 transitioned from the quarterly support provided during the Maintenance stage to the Check-in stage and routine coaching/mentoring ceased from June 2024. The project-supported SDPs receive differentiated levels of intervention over time in the Preparatory/Intensive, Maintenance, and Check-in stages of the project. Interventions in the Preparatory/Intensive stage for the 7733 SDPs engaged in PY3 were completed in June 2024. The project initially provided monthly onsite coaching/mentoring to these SDPs before transitioning to quarterly onsite coaching support provided during the Maintenance stage.

THE GOAL 

The goal of the project was to establish a successful business model for the private sector to provide quality FP services to adolescents and young people in Nepal.

OBJECTIVE:

1. Improved the technical capacity to deliver quality, client-centered FP services, including counseling, contraceptive methods, and referrals to young people, including adolescents (15 to 19 years) and emerging/young adults (20 to 29 years).
2. Enhanced managerial and overall institutional capacity towards offering services in an equitable, profitable, and sustainable manner.

GEOGRAPHIC FOCUS

Key Accomplishments Across MPHD Priority Technical Areas

Private Sector Engagement:

Adolescent responsive contraceptive service (ARCS) readiness was enhanced through continued capacity strengthening of 916 project-supported service delivery points (SDPs) (105 SDPs engaged since PY1-21 and 811 SDPs as part of scale-up in PY32) through training, monthly Quality Assurance/Quality Improvement (QA/QI) assessments, and onsite coaching to help these SDPs deliver quality FP services; carrying out health facility-initiated demand generation (HFIDG) activities; and adopting good business practices relating to business planning, record keeping and financial management. All SDPs were supported to ensure the availability of i) a counseling space to maintain the privacy and confidentiality of clients; ii) at least one adolescent sexual and reproductive health (ASRH) trained provider; iii) ASRH booklets for adolescents; iv) stock of at least four short-acting contraceptive methods; and v) referrals for Long- Acting Reversable Contraceptive (LARC) and permanent methods, to ensure access to a wide range of FP services. To expand FP method-mix in the private sector, selected providers were trained in implant and depot-medroxyprogesterone acetate- intramuscular (DMPA-IM).

Person-Centered Care:

MPHD Nepal created multiple mechanisms to advance person-centered care by collecting clients’ perspectives to inform program-level and SDP-level decision-making.

The Person-Centered Contraceptive Counselling (PCCC) scale was included in the online client feedback mechanism and client exit interviews to measure person-centeredness of contraceptive counselling at each SDP. The online client feedback mechanism was institutionalized for all 916 SDPs engaged with the project. Client feedback was also shared with owners and providers through real-time dashboards to collectively resolve challenges to providing high-quality person-centered services.

Localization:

MPHD Nepal engaged with the three tiers of national, provincial, and local governments to strengthen private sector engagement and increase stewardship and collaboration with the private sector providers and owners. The project: i) collaborated with Provincial Health Training Centers (PHTCs) to provide 42 onsite coaching and mentoring visits to improve implant services from private providers; ii) conducted 62 joint monitoring visits with municipality governments to private sector SDPs to promote engagement with municipality health priorities and encourage sustained government monitoring of private sites; iii) supported SDPs to submit their service data to the respective municipal authorities; iv) trained 107 private providers on health service data integration into the government system resulting in SDPs reporting regularly; and iv) conducted quarterly engagements with provincial (16 meetings) and municipal (308 meetings) stakeholders to strengthen public-private linkages.

KEY ACCOMPLISHMENTS THAT DELIVERED RESULTS

• Progress Against Intermediate Outcomes. The assessment of 8284 SDPs conducted in September 2024 against intermediate outcomes in the MPHD Monitoring, Evaluation and Learning (MEL) plan showed that: 779 (94%) met ARCS readiness, 805 (97%) had a basic ASRH trained provider available, 828 (100%) had provided contraceptive services to at least one adolescent in the last three months, 797 (96%) scored ≥85% in the QA/QI assessment, 718 (87%) met the minimum standards of quality FP counseling and services, 817 (99%) had initiated FP demand generation activities, 820 (99%) scored ≥80% in business knowledge and practice, and 815 (99%) had used their monitoring data to modify activities or strategies.

• Supported technical capacity strengthening of SDPs to deliver quality FP services for adolescents and young people. Altogether 1,155 providers were trained on ASRH; 1,062 providers were trained on Sangini/ (DMPA-IM); and 3,015 providers/owners received ASRH whole site orientation that also includes FP value clarification and attitude transformation exercises.

• Expanded FP Method Mix Available in Private Sector SDPs. In collaboration with PHTCs, implant training was completed by 36 providers from 36 SDPs of which 27 have started providing services. Post training coaching and mentoring was conducted in each province by the national LARC mentors to 42 implant service providers.

• Integration of Health Service Data from MPHD-Supported Polyclinics and Hospitals into the Government Reporting System. A total of 107 staff from 48 polyclinics and 44 hospitals participated in a three-day government endorsed Health Management Information System (HMIS) and District Health Information System2 (DHIS2) training. They were equipped with the HMIS tools, and 38 SDPs were supported to obtain a reporting unit in the DHIS2 system. As a result, 63 SDPs continued self-reporting into the government DHIS2 system, and the remaining SDP were in process of self-reporting.

• Conducted targeted community events in the Chhalfal Chautari format to raise awareness of FP/RH services and establish linkages with trained providers at project-supported SDPs. A total of 56,264 people in six intervention provinces were reached by 1,7,23 targeted community events, among which 42,914 (76%) were 15–29-year-olds young people. These events comprised games, storytelling, and discussions on contraceptives to dispel myths and misconceptions. Participants were also provided with the name, contact details of their nearest MPHD-supported SDP to improve FP service access. Of the total, 73 (4%) events were held in youth clubs, 495 (29%) events were held in community and 1,155 (67%) events were held in schools.

• Enhanced Business Acumen of Private Sector SDP Owners. MPHD Nepal provided Business Skills Training (BST) to the owners of 863 SDPs during the life of the project that intended to be equipping them with essential management and demand generation skills and strategies to ensure long-term sustainability and leverage competitive advantages. Following the training, SDP owners were offered the possibility to join five virtual sessions on marketing, client servicing, taxation, business strategy, and registration.

• Organized Monthly Provider Cluster Meetings to Build an Enabling Environment for Private Sector Provision of High-Quality FP Services. A total of 651 provider cluster meetings were organized in 67 intervention municipalities to facilitate knowledge exchange and diffusion of ideas among private providers and owners5. The meetings also engaged municipal authorities on priorities such as SDP license renewal, HMIS data reporting, feedback on targeted community events, waste management, and data use for data-driven decision making.