Yesterday we met with the Sarangkot Health Post Chairman and a committee of local leaders. Our goal is to advocate for Sarangkot to invest government funding in their dental clinic, our longest-running one. This is part of a larger strategy of bringing rural dentistry into Nepal’s nation-wide Health Post network, which we’re only really beginning to dive in to deeply now that we’ve sorted out the clinic model itself.
A normal meeting in Nepal will begin, at best, 30 to 60 minutes after the stated starting time. In villages, it is not unusual for this to be doubled: our Oral Health Coordinator trainings, which involve teachers from all over the village, frequently start at least two hours late. It’s just a given, and if you’re Nepali you are pretty down with the long waiting period prior to your carefully planned program. If you’re me, you basically never get used to the feeling of dread that nobody has shown up, all is lost, nobody cares about anything, and you were way overly optimistic to be in this line of work anyway. Inevitably, just when you’ve chewed your nails down as far as they will go, people show up and casually take their seats.
Amazingly, however, when the four of us arrived at the Sarangkot Health Post on two motorbikes at 1:25pm for a 1:30pm meeting, about 10 local leaders were seated and waiting patiently for us in the chairman’s office. I think I’ve seen that happen…maybe never.
It’s important to know that Nepal has not held elections at the local level since the early 2000’s. Instead of an elected local government, most villages have a handful of people – probably 95% men – who are socially (or self) appointed to make decisions, plus a village chairman and a Health Post chairman, who are both appointed by the district government. These village Committees have power over spending but have no direct obligation to represent the needs or desires of local residents. For us, that means convincing a committee of influential people and two all-powerful officials that the dental clinic is not only worthwhile, but should be a spending priority. If there’s a code to crack on getting village residents to apply pressure, we haven’t found it yet.
Our meeting with Sarangkot went amazingly. Aamod and I had invited the Health Post chairman for coffee a few days earlier and he received us with some expected concerns and doubts, but with an open mind. A few days later, we found the committee gathered in his office to be genuinely interested in talking with us and quick to acknowledge that, notwithstanding the flush torrent of external funds in to Nepal, any new health service for rural people is not truly stable unless it can be incorporated in to the government health care system. Our proposal was that we would invest $1000 in new supplies and training for the Sarangkot clinic, upgrading it to our current infection control standards, if the government agreed to pay the salaries of the technician and assistant.
They said yes.
Not to the amount we’d hoped for – $1000 per year – but to a lesser amount that is reasonable (our original hope was a serious long shot, given that the district and central levels do not recognize oral health as a funding priority, and they finance village budgets). After a lot of discussion, we came to a decision that was duly recorded in the meeting minute book and signed by everyone present. This involves a commitment for the local Committee to include oral health in their requested budget for the next fiscal year starting in July 2017 (which gets submitted in November), and for the intervening year between this July and next, to submit a proposal to the municipality for an emergency amount that will help bridge the gap. They are also preparing to move the dental clinic in to another room that is bigger, cleaner and more secure.
There are still many unknowns – meeting minutes definitely aren’t action, and they definitely aren’t funding. Some critical steps are up to people higher up, where we are also moving in to advocacy. It will be important for us to monitor and collaborate in this process, following up on the agreed timeline, offering support to Sarangkot’s funding proposals. There are lots of places where things could fall through. BUT, we got through an important step one more successfully than any of us expected, which is that everyone appears to have agreed it’s worth trying.
In the short term, the new room is to be ready in two weeks. We supplied paint and set some other requirements: secure doors and windows, removal of storage that is not related to the dental clinic. After that, we will provide various supplies and training in stages, at pace with the progress of Sarangkot’s investment in the people.
Good start. Now, on to Bharat Pokhari!