Nepal Clean Home Delivery Kit: Evaluation of the Health Impact - Path

most common in Siraha. The trained TBA was the most frequent one to recommend kit
use in all three districts (40-52%), with health workers or
Save the Children U.S. staff next (especially in Morang and Sunsari). Those who attended
antenatal care were much more likely to have seen or heard of the kit
(76% vs. 55%). Of those who actually used a kit, though, there was no difference between
antenatal care attenders and non-attenders as to who advised them to use the kit. In
Morang and Sunsari, the trained TBA was the one most likely to have purchased the kit
used, followed by the woman herself (Table 16). In Siraha, trained TBAs and family
members were about equally likely to have purchased the kit. This was greatly influenced
by who attended the delivery. Among those attended by a trained TBA, 61% were bought
by the TBA herself, followed by the husband, and then the woman herself as the next
most common purchasers. Among those with an untrained TBA, the woman herself was
the most likely purchaser (25%), followed by health workers, relatives, and husbands.
Among those attended by family or neighbors, 37% of kits were bought by the woman
herself, followed by health workers, family members, and trained TBAs as the next most
common purchasers. When the birth was attended by a health worker, the health worker
purchased the kit half the time and the woman herself was the next most common
purchaser.
In Morang and Sunsari, the kit was commonly purchased directly from the TBA (with no
information as to where she got it), while in Siraha the pharmacy was the most common
source. Very few were bought in retail shops. Again, it was influenced by who attended
the delivery. Of those with a trained TBA, 56% bought their kit directly from the TBA.
Those with an untrained TBA were equally likely to get their kit from a TBA, a female
community health volunteer (FCHV) or a pharmacy. Those attended by family or a
neighbor or friend were most likely to get the kit from a FCHV or health post. Those
attended by a health worker were most likely to get the kit from the health post or from a
TBA.
In Morang and Sunsari, kits were most commonly bought one to three weeks before the
birth, while in Siraha almost half waited until less than a week before the delivery to buy
the kit. In all three districts, about a quarter were brought by the attendant at the time of
labor.
The price paid for kits varied considerably both within and between districts. In Siraha,
74% paid Rs.20 or more for their kit, vs. only 31-33% elsewhere. Morang had the most
free or subsidized kits (28% vs. 13-14%).
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Nepal Delivery Kit Evaluation May 2000