Nepal Health Education Partnership

This project is currently recruiting for the 2024-2025 cycle.

Overview:

The University of British Columbia (UBC) Nepal Health Education Partnership NHEP,) aims to advance public health and health literacy in rural Nepal through educational programs and advocacy efforts. NHEP is comprised of two key initiatives including The Nepal Sexual and Reproductive Health (SRH) Project and the Nepal Sickle Cell Disease (SCD) Project, both of which include health education as their core components.

The UBC Nepal Health Education Partnership began in the summer of 2015 when 12 UBC medical students visited the rural province of Dang, Nepal. In partnership with Creating Possibilities (CP) Nepal, a local non-profit organization they engaged local residents and health professionals to screen for Sickle-Cell Disease (SCD) among the indigenous Tharu population and improve education about its prevalence and impact. The need for this work was highlighted by CP Nepal and subsequent research with highlighted the significant higher prevalence of SCD among the Tharu population.

Over the years, NHEP has provided consistent support for the SCD Education and Screening Program and, more recently, the Pain Education and Management Program in Dang. The team continues to make annual visits to Dang, focusing on community education and advocacy for SCD, conducting mass screenings, health assessments, and resource development.

Although our partnership with CP Nepal initially began with a focus on SCD, it has since expanded to include adolescent health education. In 2020, CP Nepal identified sexual and reproductive health (SRH) as an area of need among local adolescent girls. Together, we developed the Adolescent Health Program, a 10-module curriculum based on the International Technical Guidance on Sexuality Education created by UNESCO. By empowering adolescent girls with vital SRH knowledge, our hope is to improve access to and utilization of sexual health services, reduce social stigma, and generate discussion to address inequities in sexual and reproductive health.

Due to the success of these programs, our work in SRH has continued to expand with a recent focus being placed on the importance of including boys in the SRH conversation. CP Nepal and NHEP are now working together to create and administer mixed-gender modules based on the direct input and feedback of adolescent girls, boys, and health professionals. Additionally, based on the guidance of CP Nepal, a preliminary needs assessment was completed to assess mental health literacy amongst the Dang adolescent population. Based on these findings, subsequent literature reviews, and reports from CP Nepal, mental health literacy was identified as a key need amongst this population. NHEP and CP Nepal are now also working to expand the Adolescent Health Program to include education regarding mental illnesses, management strategies, access to services, and suicide prevention tools.

NHEP’s main objective is to create and implement educational programs that enhance health outcomes in Dang. To accomplish this, the partnership has conducted various health needs assessments in collaboration with CP Nepal and continuously gathered program data for quality improvement. To disseminate the results of screening programs, needs assessments, and our educational initiatives, the NHEP team actively participates in knowledge translation. In recent years, they have showcased their findings through poster and oral presentations at multiple conferences across North America, including the Canadian Conference on Global Health and the Western Medical Research Conference. Through presenting at conferences, we hoped to lay the groundwork for similar initiatives in other countries.

Adolescent Health Program

To date, our Adolescent Health Program has enabled over 800 girls from three municipalities in rural Nepal to receive comprehensive SRH education. Taught by local educators, the curriculum covers topics ranging from puberty, menstruation, and reproduction to child marriage and gender equality (see below image). The program has been well-received, with growing interest from local communities and governments requesting further expansion.

To support the sustainable delivery of a standardized curriculum, we have created a Training-of-Trainers (ToT) manual of our 10-session program to be used by current and future educators as the program continues to grow. For the 2024/2025 year, we will continue to update our ToT manual based on feedback from students and educators. CP Nepal has expressed a need for incorporating mental health education into our program, which will be a focus of this year. We have also begun piloting our sessions to include boys, founded on our belief that achieving SRH equity necessitates the involvement of all genders.

Table 1. The ten-sessions of the Adolescent Health Program as of 2024

Research

1. Mixed-Gender Classrooms
The Nepali community identified a need for an abridged mixed-gender class, highlighting the importance of increasing SRH literacy amongst all genders to drive cultural and system- level change. A pilot mixed-gender session covering adolescent health, gender equality, and child marriage, was delivered to 30 students in 2022. In 2024/2025, a thematic analysis of student feedback will be completed and used to generate a report for CP Nepal. Using these results, we aim to work with our educators to finalize the abridged mixed-gender program and begin the inclusion of adolescent boys in our SRH curriculum.

2. Mental Health Program

During our onsite visit in 2023, CP Nepal brought to our attention the need for mental health education within the community. As we visited classrooms, we learned about the escalating rates of suicide and a lack of awareness regarding mental illnesses. Nepal currently grapples with a severe mental health crisis, marked by the second-highest adolescent suicide rate in South East Asia and limited mental health infrastructure. This crisis disproportionately impacts rural adolescent girls who face gender-based inequities. Many girls expressed that suicide could be seen as a viable option if they were to experience a pregnancy before marriage, driven by the burden of shame and social discrimination.

As part of our mixed methods study, we will also be performing a mental health needs assessment among participants of the Adolescent Health Program to gain a better understanding of the mental health landscape within the community. Our needs assessment is a 64-item survey, organized in a three-point Likert response scale (1=disagree; 2=neither agree nor disagree; 3=agree) including five sections:

1. knowledge about mental health problems including specific knowledge on 5 mental disorders (Major Depressive Disorder, Generalized Anxiety Disorder, Schizophrenia, Substance Use Disorder and Eating Disorders);
2. erroneous beliefs/stereotypes;
3. first aid skills and help seeking behaviors;
4. self-help strategies;
5. curriculum delivery.

Ultimately, we hope to incorporate a mental health session into the program and equip Nepali youth with tools to navigate mental health challenges and foster resilience in their communities.

From 2015 to 2024, 6083 individuals have been screened, with 8.96% testing positive. Among those who completed follow-up diagnostic testing, 3.85% were confirmed to have SCD, and 54.8% were found to carry the sickle cell trait. Recognizing the need for improved SCD awareness, the project introduced culturally sensitive educational modules, explaining the causes, symptoms, and inheritance of SCD for the local population. The team assists with delivering these SCD educational workshops to the local health workers. Additionally, the team collaborates with CP Nepal staff to host “forum theatres”– educational plays in public community spaces – where up to 200 locals gather to watch the story of a family who goes through the process of screening, diagnosis and treatment for SCD.

Future Plans

The UBC SCD Project continues to adapt and expand to meet local needs. Our future directions include:

• Continuing Annual SCD Screenings to monitor and address disease prevalence.
• Expanding SCD Education Initiatives through workshops, public events,
• Enhancing Pain Management Training Modules based on participant feedback tooptimize content and delivery.
• Developing New Educational Modules for School Children on topics such as SCD,hygiene, responsible antibiotic use, and basic first aid