Dr. Biraj Karmancharya, Department of Global Health alumnus, graduated from University of Washington with a PhD in Epidemiology in 2015 and an MPH in Global Health: Leadership, Policy, and Management in 2017. He was the founding co-director of the Nepal Studies Initiative at the South Asia Center, Jackson School of International Studies.
When Dr. Karmacharya, head of community programs at a sprawling university hospital in the eastern town of Dhulikhel, first began to visit remote Nepali villages, he quickly learned that health issues took second place to financial concerns.
“One thing we realized was that in order to have a long-term relationship with the community—to engage them in health in a sustainable way—we had to devise another approach rather than preaching to them,” he said.
Dr. Karmacharya opted to try microfinancing as a way to grant women financial independence and the opportunity for regular health checks and education.
“It was a wild idea,” he said, but he managed to secure foreign, mainly European donors for the project. “We thought that it would financially empower [women] and get the women organized—that the power center in the communities would be changed.”
Today, hundreds of women have been drawn into a life-changing sexual and reproductive healthcare system through a unique microfinancing scheme that is one-of-a-kind in Nepal and remains relatively uncommon globally as a combination of the fight against poverty and the pursuit of improved community health.
Since it began in 2008, the scheme has provided more than 1,000 women with small loans ranging from 10,000 to 25,000 Nepali Rupees (£67-169) over a period of three to four years. The money is used to fund the growing of marketable vegetables or raise poultry, and participants have monthly accounting meetings to arrange loan repayment. The women are also required to attend a monthly health education class where they can speak openly about medical issues and receive vital check-ups like cervical cancer screenings.
As a result of the scheme, in addition to financial profits and free agricultural training, the women have reportedly benefited from increased self-confidence. Wives and mothers who had previously existed alone in the shadows, speaking only in a local dialect, are now bold enough to speak publicly in Nepali. Their new assertiveness, borne through group support, has helped them to deal with local men who accused them of neglecting their housework.
While conclusive data on the program’s overall success is still being collated, anecdotal evidence suggests that health goals are being reached. A 2015 study on attitudes to cervical cancer screening in rural Nepal, published by the American Association for Cancer Education, and based on 122 women, showed that the proportion willing to undergo a screening shot up from 15.6 per cent to 100 per cent after a community education class.
“Previously, women were hesitant to take home pamphlets on sexual health, fearing the reaction of their husbands and in-laws, but they are now much more open,” said Gita Giri, a midwife who conducts 22 monthly health classes.
According to Dr. Karmacharya and local leaders, women’s financial independence and new support networks have also substantially reduced domestic violence.
“There are women who say they are more confident, that their husbands no longer beat them. It changes the power dynamics,” he said.
While healthcare debates often center on new technology, Dr. Karmacharya argued that the design of new delivery systems and approaches was less “glamorous” but fostered real change.
“My firm belief is that the solutions to the problems are best found in the places where the problems lie. The Harvards and Oxfords of global health shouldn’t be in Massachusetts or Cambridge, they should be in places like this,” he said. “I cannot change the world but if I can create a good model of success, then people will learn from that.”