Does aid work? Ask Nepalese women.

June 18, 2009

     By Duncan Green     

Ok I’m getting tired of picking holes in the arguments of aid sceptics, so here’s something positive – a specific example of what aid can achieve in a country like Nepal, which is recovering from a decade of conflict with devastating consequences for the delivery of basic services. One third of its population lives below the poverty line and one woman dies every two hours during pregnancy and childbirth.

Together with other donors, the UK gives money directly to the Nepalese government for the health sector, allowing it to scale up and strengthen its public health system. In January 2008, aid helped the government of Nepal to abolish user fees in health care. Nepal has made impressive progress. In just 5 years the under five mortality rate was reduced by around a third and since 1996 the maternal mortality rate has fallen by 50%. Nepal is on target to meet the Millennium Development Goal on child mortality before 2015 if present trends can be sustained.

The Safe Motherhood Programme is an example of co-ordinated support for the government health system, with a specific focus on saving women’s lives. The UK has provided £20 million over five years to finance the programme, which trains doctors and nurses, improves health care facilities, provides equipment and encourages women to give birth in hospitals where qualified health workers can oversee their delivery and deal with any complications.

The Programme incorporates the innovative Maternity Incentives Scheme, which pays women to give birth in a hospital or health centre. Transport costs in Nepal are high, and there are very few good roads in the most mountainous provinces. In the past, these factors have prevented many women from travelling to a hospital or health centre to give birth. All across Nepal, women who give birth in a hospital or health centre now receive an average of 1,000 rupees (£7.50) after the birth of their first and second children. In most cases this is enough to cover transport costs and may even leave some money over to buy essential items for the new baby. Another aspect of the scheme is the payment to health workers of 300 rupees for each birth that they attend. This includes home deliveries, and is therefore an added incentive to make the sometimes arduous journey to rural areas to attend births.

What has been the impact?  As well as the impressive decrease in the maternal mortality rate, over the last decade the percentage of births attended by a doctor, midwife or nurse has increased by 10% and in the past year an extra 60,000 women were able to give birth in health facilities.

Don’t get me wrong, there’s still a long way to go, especially on maternal (rather than child) mortality. Nine out of ten mothers still deliver their babies at home without a doctor, midwife or nurse. It is estimated that health spending in Nepal (both public and private) is around a half ($14 per person) of that recommended for developing countries by the Commission on Macroeconomics and Health ($34 per person). The share of government health expenditure is less than $5 per person.

For more on this and other case studies of aid effectiveness, see here. For a powerpoint on the Nepal Safe Motherhood Programme see here.

June 18, 2009
Duncan Green