Using new evidence to support data-driven programming in Nepal

A women's group in the Ramechhap district of Nepal.
A women's group in the Ramechhap district of Nepal. | Credit: Nepal CRS Company

A new brief details how SHOPS Plus supported a Nepali social marketing organization to use locally relevant data to make evidence-based, district-specific program decisions. SHOPS Plus collected data from hundreds of women in four rural hill districts with extremely poor reproductive and child health indicators. Using a knowledge, attitude, and practices (KAP) survey, they pinpointed barriers and motivators to healthy behavior adoption in the areas of contraceptive access and choice, diarrhea treatment and prevention, antenatal care, and facility delivery. The Nepal CRS Company, a local social marketing organization and SHOPS Plus partner, used the findings to inform social and behavior change campaigns for its initiative in remote areas—called the Remote Area Initiative (RAI).  

“We didn’t want to make assumptions about the experiences of women living in each district. As the brief summarizes, we found substantial differences in health practices across the four RAI districts,” explains Tess Shiras, research, monitoring, and evaluation specialist for SHOPS Plus. “Tailoring the program to each community’s knowledge, attitudes, and practices allowed activities to be responsive to identified behavior change barriers and better resonate with community members.”

Map of Nepal highlighting RAI districts
Map of Nepal highlighting RAI districts.

CRS adapted the social behavior change activities in each of the four districts based on findings. For example, in Terhathum the program focuses on facility delivery because the survey found that over half of recent mothers in the area delivered at home. In Tanahu, women’s groups emphasize antenatal care because less than two-thirds of recent mothers received all four recommended visits. Ramechhap’s curriculum concentrates on water treatment due to high use of untreated water. 

Notably, the survey found that across the four districts, nearly one-third of recent mothers delivered at home without a skilled birth attendant and almost half of these mothers reported that delivering in a health facility was “not necessary.” The RAI created men’s groups to encourage men to play a positive role in supporting the women in their lives to seek appropriate care, such as planning for a facility delivery.

A RAI educational poster on effective water treatment methods
A RAI educational poster on effective water treatment methods

The survey also found that mothers had conflicting ideas about effective childhood diarrhea treatment. For example, over half of mothers thought antibiotics and antiprotozoals were the best treatment. Half also said that oral rehydration solution and zinc were just supplements rather than essential medicines. 

“This was a key finding for us because CRS and SHOPS Plus were about to launch a new ORS and zinc co-pack,” notes Jiblal Pokharel, managing director of CRS. “We conducted follow-up qualitative research to learn more about caregivers’ perceptions of various treatments and their decision-making processes around diarrhea care seeking and treatment. Ultimately, this informed the messaging in the RAI program and the marketing of the new ORS and zinc co-pack.” 

Read the full brief to learn more about how SHOPS Plus collected timely and actionable data to develop evidence-based social and behavior change programs.

Learn more about our work in Nepal and in research and evaluation.

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Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is a five-year cooperative agreement (AID-OAA-A-15-00067) funded by the United States Agency for International Development (USAID). This website is made possible by the generous support of the American people through USAID. The information provided on this website is not official U.S. government information and does not represent the views or positions of USAID or the U.S. government.