Introduction Organisation Coverage Mission Statement Goals Strategy Achievements
Feedback Home
OVERALL PROGRAMME SUMMARY 2004 A. Economic Situation Overall GDP growth rate of the country improved gradually from -0.6 in 2001 to 3.7 in 2004 despite the rampage of uprising insurgency and frequent strikes and Bandas called by the political parties. Such appreciable growth was achieved as a result of good weather and relatively high crop yield in agricultural sector. Per capita income increased marginally from US$ 250 in 2003 to 276 in 2004. Such marginal change was contributed by depreciation of US$ compared with local currency and increased volume of remittances through periodic job migrants to Gulf countries and India. In spite of these positive changes in the economy, price hike of the petroleum products ranging from 4 percent in petrol, 13 percent in diesel and more than 50 percent in kerosene in 2004 affected the subsistence living of the poor and marginal people due to increased price of the commodity and consumers’ goods. Official inflation rate reported by the government in economic survey in June 2004 was 6.6% in Kathmandu valley and 5.1% in the country, whereas the unofficial estimate of inflation rate was in two digits. Such a high inflation rate has increased program operation cost over the year. High unemployment and underemployment rates remained one of the major economic problems in the country. About one fourth (26%) of active labour force is unemployed and nearly one-third (32.3%) employed labour force is underemployed. It has lead to high periodic out-migration of adolescents and young boys to India and other Gulf countries in search of employment opportunities, as the sluggish economy could not absorb growing labour force within the country. Out-migration of people, particularly young people, increased by 25% in 2004 compared to 2003, as they could not get any job opportunities in the country and find difficulty to stay in villages due to ongoing conflicts between insurgents and security forces. Remittance was one of the major sources to sustain the household economy. About one third (32%) of households received remittance whereas majority of households who had no family members employed in off-farm sector within the country and do not receive remittance have plunged into debts. More than two third (69%) of households had been indebted as the unemployment and underemployment grew over the time. B. Security and Political Situation The security situation of the country, particularly outside the Kathmandu Valley, was insecure throughout the program year 2004 owing to the uprising Maoist insurgency, encounters between armed insurgents and security forces and frequent strikes and Bandas called by the insurgents and political parties. The frontline service providers, grassroots level volunteers and field workers of the Association were not targeted by the insurgents. However, they had a psychology of insecurity for free movement from one place to another during the strikes and Bandhas. Similarly, the political situation of the country was highly unstable during the program year. Even the caretaker government led by Lokendra B. Chand resigned on 8th may 2004 and the King reappointed Surya B. Thapa as new Prime Minister. The tenure of the people’s representatives in local governments was over in 2001 and fresh election could not take place in time. Grassroots level development activities in public sector had been largely affected in the absence of elected local governments. At present, main agenda of the government is to restore peace through dialogue with insurgents and political parties. Herein lies the larger national interests and the search for amicable peace process is underway. C. Program Overview The year 2004 was the transition year for FPA Nepal. FPAN developed five-year draft strategic plan (2005-2009) based on IPPF’s Strategic Framework. In order to achieve its goals set by the five-year Strategic Plan, FPAN adopted five different strategies (Adolescents & Youth, HIV/AIDS, Safe Abortion, Access to marginalized groups and Advocacy) to implement its programmes. FPAN added two important services, including HIV VCT services in 7 branch clinics and safe abortion services in 7 clinics in 2004. The assessment of the progress made by FPAN in major programmatic areas is highlighted as follows: Advocacy FPAN implemented various advocacy activities on reproductive health, youth & gender related issues for media persons, journalists and women's groups to strengthen recognition of SRHR and to achieve greater public support for SRHR. Advocacy activities were implemented in collaboration and partnership with Nepal Bar Association and Journalists at central level and with community leaders and CBOs at district and village levels. Adolescent and Youth With a view to aware adolescents & youth of their sexual & reproductive rights and empower about informed choice and decision regarding their sexual and reproductive health, various programs through formal and informal education system, counselling services on reproductive health and sexuality, including education and services on STI/ HIV/AIDS prevention and management were organized in the operational areas. Several AYRH program components were also integrated with other programs in the branches/projects. The most effective way for communicating with adolescents & youth were Youth Information Centres, Youth Forums and mobilization of peers groups. A total of 74,329 adolescents & youth were provided with SRH counselling services during the programme year. Access of SRH Services to Marginalized and Disadvantaged Groups FPAN aimed at providing quality family planning and other reproductive health services to couples and individuals especially for marginalized and disadvantaged groups based on informed choice by increasing the accessibility and availability of RH/FP information and services in meeting the unmet needs with integrated approach. SRH information and services provided by FPAN in 2004 were as follows: i) Family Planning Services FPAN provided FP services to a total of 280,499 clients during the program year. Overall achievement in providing FP service was 150% as against the stipulated target of 186,295 clients. Percentage share of new clients in total FP clients (current users) was 24 percent. The total FP users increased by 35 percent over the year. Such an increase was attributed by revision of MIS system with inclusion of last years clients who have taken clinical services (IUCD, Norplant and sterilization from FPAN clinics and non reporting of withdrawals) up to the CYP period and relatively high continuous users in condom, pills and Depo, whereas the recruitment of new FP clients decreased by 16 percent compared to 2003. Such decrease in the recruitment of new FP clients was contributed by frequent strikes and Bandhas called by the insurgents and political parties and apprehension of field workers to go at the door steps for FP counselling, follow up services and contraceptives distribution during such days. 
The method mix of family planning methods reveals higher preference for injectable Depo (35.5%), followed by condom (30.6%), oral pills (24.2%), sterilization (6%) Norplant (2.9%) and IUCD 0.6% (Figure 1). Majority of FP clients in FPAN branch and outreach clinics were using spacing methods as the programmatic focus was given to birth spacing among young people.
Analysis of clients’ age profile indicates that majority of FP users were young adults. The percentage share of adolescents in total FP users was 5.5%, followed by 26% youth and 68% young adults. It is important to note that the CPR among young people was 12 in Nepal and one third of young FP users in total FP services indicated that the FPAN programs were rightly focused towards adolescents and youth. ii) No of MCH Education/Services & Primary Health Care Services Altogether 972,588 MCH counselling, education and services including 603,029 MCH services and 369,559 education were provided to the clients through 40,884 clinic sessions conducted by a total of 651 FPA branch and outreach clinics during the program year. Provision of MCH counselling, education and services through FPAN clinics increased impressively by 23.46% in 2004 compared to the previous year (Figure 2). New MIS system introduced since 2004 has strengthened reporting system and MCH education and services provided by all clinics were submitted to MIS Section at FPAN head quarter. Reporting of service statistics of some clinics which were implemented in partnership with local CBOs and youth clubs were missing in 2003. However, they were covered completely in new MIS and as a result provision of MCH education and services grew progressively compared to 2003. Second factor contributing for such growth was an enhanced partnership with government in vaccination campaign since last few years. Fig 2: Comparison of No of MCH Education Services Provided by FPAN Clinics
(2002-2004)
The MCH services & education provided by FPAN is given in figure 2:
iii) Pathological Services Altogether, 48,078 laboratory test services were provided to the clients visiting FPAN clinics during the program year. The laboratory facilities provided by FPAN were as follows:
Provision of lab services increased by 26.6 percent in 2004 compared to previous year. Such impressive growth was attained through improvement of laboratory infrastructures and enhanced skills and knowledge of the lab technicians through training. Lab facilities were upgraded in 7 branches under JTF funded HIV VCT project, which attracted new clients for lab test services. STI/HIV//AIDS Prevention and Management HIV VCT services were first introduced in 2004 in 6 branch clinics and one central clinic. The uptake of the clinics for VCT was relatively low in the program year. A total of 106 clients received VCT services through 7 clinics. However, it is important to note that the institutional capacity of FPAN has been enhanced to provide such important services outside the Kathmandu valley. During the program year STI counselling, diagnosis and treatment services were provided to 36,299 clients through branch and outreach clinics. Total nuber of such services increased by 13.4 % in 2004 compared with 2003.
Safe Abortion Services After three decades of advocacy works to liberalize abortion law in Nepal, FPAN formally started safe abortion services in its 7 clinics in 2004 as the Abortion Procedural Order was published by the government in January 2004. During the program year safe abortion services were provided to 2,686 women to terminate their unwanted pregnancies. Similarly, 5969 pre and post abortion counselling services were also provided.
C. Financial Results FPAN received a total of Rs 104.98 million cash grant from various donors, including internal income during the program year. The share of income from various donors was 70.67 % from IPPF, 21.92 % from NON-IPPF and 7.40 % from internal income. The Association has received total of Rs. 77.40 million as cash grant including Rs. 3.21 million (received on 25/01/05) for the budgeted activities of financial year 2004 from IPPF, against the expected grant income of Rs. 81.75 million which includes grant income for Technical Support Unit of Rs.4.44 million. The cash received against the budgeted grant income has resulted in the foreign exchange loss amounting to Rs. 1.03 million. However, the total expenses during the financial year 2004 was to the tune of Rs. 76.77 millions, indicating under expenditure to the extent of Rs 0.54 millions (0.70 %). The cash grant from restricted donors for the year was Rs. 23.02 million against the budgeted expenses of Rs. 31.12 million. The excess of expenditure over cash income in this case was met through the previous year's brought forward cash balance and grant receivables of the year 2004. FPAN generated a total of Rs 7.77 million (119.29 %) as compared to budget forecast through internal sources such as sales of medicine, interests, service fee and others. FPAN received contraceptives from IPPF worth of US $ 49,517.25 as compared to budget provision of US $ 53,056.00 resulting in deficit of US $ 3,538.75 i.e., 6.67 %. Contraceptives received from KfW was worth of US$ 161,500 for injectable (Depo) against the projected amount of US$ 95,498 in APB 2004. The overall budget forecast of expenditure during the financial year 2004 from various sources was initially estimated at Rs. 114.54 million. The initial estimation was revised at Rs. 124.66 million during Half Yearly Review. The actual expenditure during the current fiscal year was Rs. 114.81 million. The actual expenditure as against the revised budget resulted in under-expenditure to the tune of Rs. 9.85 million (7.90 %) only, while compared to the initial estimated budget, the actual expenditures resulted into over expenditure of Rs. 0.27 million. i.e., 0.23 %. D. Success Overall achievement in the implementation of the programs during the program year was up to the mark. FP/MCH services were provided more than the targets set in APB. Two new services like HIV VCT and comprehensive abortion care (CAC) were successfully integrated in selected SRH clinics. E. Problems/ Obstacles Implementation of some activities like training, workshop and other orientation programs were rescheduled due to uprising Maoist insurgency and associated violence and tension. Besides, regular supervision and monitoring of program activities in some of the district branches located in remote hills and mountain districts were hampered. Frequent strikes and Bandhas called by the insurgency and political parties also hampered logistic supplies in rural clinics. The strikes were so serious that the local markets were completely closed and highways were blocked and some staff who were attending the training at district headquarters were also blocked during such unplanned strikes. Some of the projects like HIV VCT were materialized in the second half of year due to delay in the approval and finalization of project and subsequent preparation required for the project implementation. Contraceptive shortage was faced during the year to provide family planning services to the clients in the FPAN's operational areas. However, some quantity of contraceptives was received from government outlets at district levels, as a result program was not seriously affected due to shortages. Out-migration of adolescents and young from their rural households to cope with growing conflicts between armed insurgents and security forces also affected peer education programs to some extent in western parts of Nepal. As the trained peer educators were out-migrated from their villages new peer educators were trained to continue the programs. Monsoon flood, which normally happen in June-July every year also affected program implementation to some extent. Six district branches were affected by the floods as it damaged some outreach clinics. These clinics were later renovated through flood rehabilitation and reconstruction project funded by IPPF. F. Outside Assistance During the program year FPAN received financial and technical assistance from different organizations. FPAN received technical support and expertise for undertaking training program for service providers from government and teaching hospitals. Similarly, contraceptives were received from KfW through HMG Nepal. G. In-kind Contribution The in-kind contribution mobilized by the Association during the program year included free accommodations provided by the community for outreach clinics and service centres. Some of the construction materials like bricks; stone, sand gravel and timber received from the community for construction of branch clinic in valley, Ilam and Makwanpur district districts. H. Conclusion The achievement made by the Association during 2004 in providing FP services to the clients was 150% as against the expected results. The program interventions made by the Association in the field of AYRH remained very encouraging. Hence, the objectives envisaged in the APB 2004 under different strategies were fully realized. 
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||