The History of BNMT 1960s and 70s

Read about our beginning in this article by BBC:  https://www.bbc.com/news/world-asia-46558563

Getting Started – 1960s

1966 – First approach made to the Government of Nepal, offering to supply a team of British doctors and nurses.

1967 – HRH Princess Shah becomes Royal Patron. BNMT officially registered as a British charity.

1968 – A team of eleven doctors, nurses and a mechanic arrives overland in Kathmandu. Work started in Biratnagar General Hospital with rooms re-equipped, pathology laboratory established, patient record system introduced, drugs and equipment donated. Improvements to operating theatre initiated. Building of nurses’ home and children’s ward begun. Similar works performed at Dharan Hospital. Mobile BCG team starts work in Morang district. Team members assist at mother and child health, family planning and ante-natal clinics in Biratnagar and Dharan and train Nepalese nurses.

1969 – BCG work started in Sunsari district. TB and BCG health education materials produced. Blood donor system established in Biratnagar. Dhankuta TB/leprosy clinic and pathology laboratory opened. Hill Drugs Scheme starts with four shops. Mother and child health, family planning and ante-natal clinics extended to Dhankuta. Surgeries held and preventative medicine lectures given in Dhankuta. BNMT provides a doctor for the construction workers on the British section of the East-West Highway.

A Million BCG Vaccinations – 1970s

1970 – BCG teams continue in lowland districts and start in Dhankuta. Six Hill Drugs Scheme shops running. Drugs supplied to some government hospitals and health posts in hill districts. Mother and child health, family planning and ante-natal health education materials produced. BNMT arranges for Dhankuta town water supply to be iodised.

1971– Biratnagar Hospital outpatients’ department and pathology laboratory buildings completed. Eight Hill Drugs Scheme shops in operation.

1972 – BCG work started in Sankuwa Sabha district

1973 – Chainpur clinic opened in Sankuwasabha district. Dhankuta clinic X-ray equipment installed

1974 – Emergency treatment and vaccination programme against cholera epidemic in Saptari district.

1975 – Last recorded case of smallpox in Nepal. Major improvements to Biratnagar Hospital completed.

1976 – Millionth child receives BCG, in Dhankuta. BCG work started in Jhapa district. Thirty-one Hill Drugs Scheme shops operating.

1977 – Tehrathum and Bhojpur clinics opened. X-ray machine donated to Bhadrapur Hospital. BCG work started in Bhojpur and Panchthar districts. First Hill Drugs Scheme shopkeepers’ seminar held.

1978 – Khandbari clinic opened in Sankuwasabha district. BCG work started in Tehrathum and Khotang districts. BNMT starts training and supervision of village health works in Sankuwasabha district.

1979 – Phidim and Taplejung clinics opened. BCG work started in Okhaldunga district. Nutrition unit opened in Khandbari

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The History of BNMT 1980s

Increasing Local Skills

1980 – Goitre survey undertaken in Sankuwasbha district. First Cost Sharing Drug Scheme established in Bhojpur. Community Health Leader training started in Sankuwasabha.

1981 – Mass iodised oil vaccination campaign undertaken. Health post drug manual published. Drug shopkeepers training course held. Primary health care survey commenced in Mamling.

1982 – BNMT registered in the United States as a charity. First Bhojpur Drug Scheme seminar held. Community Health Leader programme extended to Dhankuta district.

1983 – BCG campaign completed in all districts of the eastern region. Maintenance work handed over to the Government health service. Hill Drugs Scheme shopkeepers’ refresher course held. 49% cost recovery achieved in Bhojpur Drug Scheme.

1984 – HRH Princess Helen Shan becomes new Royal Patron. Multi-drug therapy for leprosy started in most districts. Eleven Hill Drugs Scheme retailers finish government training. Bhojpur parasite survey conducted.
                       
1985 – HRH The Prince of Wales becomes Royal Patron. Support to the Nepal Anti-TB Association started, comprising provision of supplies and seconded staff. Animal Drugs Scheme established.

1986 – Clinic opened in Diktel, Khotang district, making a total of eight TB/leprosy clinics in eight hill districts. 70 Community Health Leaders trained in preventive and curative health work. Women’s literacy classes started in Sankuwasbha.

1987 – Cost Sharing Drug Scheme expanded to Taplejung. 200 patients received leprosy treatment at BNMT clinics. Involvement of expatriate doctors in TB/leprosy work reduced as local staff improved their skills.

1988 – Women’s literacy and health education expanded in Sankuwasabha district. Female Community Health Volunteers training programme established.

1989 – Start of integration of BNMT TB/leprosy work into the Government’s health service. Cost Sharing Drug Scheme expanded to Panchthar. Animal Drug Scheme handed over to a local livestock programme. Seminars on rational prescribing held in Cost Sharing Drug Scheme districts. Literacy training now planned and taught by Nepali staff.

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Towards Sustainability– 1990s

1990 – Cost Sharing Drug Scheme expanded to Khotang district. First TB training held for government health workers in lowland districts. Street Theatre established, to promote health messages. Training Unit established to improve staff training skills. Traditional healers’ training started.

1991 – All 29 Hill Drug Scheme shopkeepers awarded licences. Community Health Volunteer programme handed over to the government. School Community Development Programme started.

1992 – TB and leprosy work reorganised, introducing new TB treatment regime and expanded role for Nepalese staff. Water projects undertaken by school community groups. Drugs supplied to Bhutanese refugee camps.

1993 – TB training plan for lowland districts finalised with government officials. Attendance at health posts, supplied by the Cost Sharing Drug Schemes, shown to be higher than average and increasing. First Women’s Groups formed amongst literacy students.

1994 – Appointment of Mahesh Sharma, first Nepalese Director. 88% cure rate achieved in TB programme. All lowland districts covered by six-day training in TB. Street Theatre team performed 60 dramas and puppet shows and two training sessions to teach theatre skills.

1995 – TB case finding programme handed over to the Government. Five new Hill Drug Scheme shops opened. Cost recovery improved with introduction of graduated fee scale for patients at government clinics. Major review of community health and development work.

1996 – New TB treatment observing patients taking drugs (DOTS) started in Dhankuta as pilot for national scheme. Regional TB diagnosis quality control centre established. Transportation of drugs to health posts taken over by local health committees. Women’s Groups adopt project cycle approach.

1997 – Participatory review of BNMT strategy completed. DOTS pilot scheme achieves cure rate of 90% for new TB cases. BNMT clinic in Ilam handed over to the Government. Three-year evaluation of Drug Schemes completed. Cost recovery of up to 130% achieved by some drug shops. Training Unit phased out owing to completion of work.

1998 – Special action project for the elimination of leprosy undertaken in Sankuwasabha district. BNMT supplies 46% of drugs used in government clinics in the Cost Sharing Drugs Scheme. The Hill Drugs Scheme evolves into the Community Hill Drug Scheme; a community run programme at sub-health posts. Women’s groups focus their activities on health needs.

1999 – New partnerships with local organisations entered into and existing partnerships strengthened. Rapid expansion of the DOTS regimen of TB treatment throughout Nepal. Training, workshops and street theatre continue to address the health issues of communities. The child-to-child approach to health education and rational drug use introduced through training courses for teachers and students in Bhojpur and Sankhuwasabha.

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The History of BNMT Post 2000

A Rights-Based Approach to Improving Health

2000 – Integration of TB/leprosy services into the Government system completed in eight hill districts and support for the National TB Programme in the Central Development Region increased. A Community Health and Development Programme training team established in Sankhuwasabha and Khotang districts. The Community Hill Drug Scheme implemented in 16 sub-health posts and the Cost Sharing Drug Scheme in 5 districts of Khotang, Bhojpur, Panchthar, Tehrathum and Sankhuwasabha. Senior staff members move from Biratnagar in the Eastern Development Region to Kathmandu to improve development networking and liaison.

2001 – Majority of senior staff members are now Nepalese. TB/HIV/AIDS focused pilot project started in Sunsari District. The Community Health and Development Programme moves away from direct implementation to training and support of local partners. The Community Hill Drug Scheme is operating in 22 sub-health posts.

The Nepali Royal Family massacred and Prince Gyanendra is crowned king. General strike called by Maoists brings the country to a virtual standstill. Government arrests anti-government demonstrators, including student and opposition leaders. The deteriorating security situation prompts the development of security and emergency guidelines.
                       
2002 – A new strategy which introduces health rights-based activities and an integrated programme of management of new and existing work for 2003-07 developed. BNMT’s drug stores handed over to drug suppliers selected by District Health Coordinating Committee. The TB/HIV pilot project encourages increased numbers of patient to seek health checks and treatment for sexually transmitted diseases. Responsibility for TB hostels handed over to the Government. Leprosy virtually eliminated in the hill districts and responsibility handed over to Netherlands Leprosy Relief.

Clashes between the military and Maoists of increasingly violent intensity. Concern over US and UK support for “Nepal’s war on terrorism.”

2003 – Chanda Devi Rai appointed BNMT’s first Chief Executive Officer. Five year Health Improvement Programme started. 152 health institutions delivering WHO’s essential drugs through cost sharing drug schemes in six districts. A health education programme in five schools organised. BNMT expands support for the national TB programme to two more districts, Okhaldunga and Solukhumbu. Urban TB programmes started in Jhapa, Morang and Sunsari. Drop-in centres for injecting drug users started in collaboration with local organisations. Malaria eradication programmes through mothers’ groups implemented in the lowlands.

Internal armed conflict continues, moving from Western to Central and Eastern Nepal. BNMT adopts a “neutral” approach in its work.

2004 – A wide ranging survey of health needs of disadvantages and other communities in all 16 districts of the Eastern Development Region, as a baseline and planning tool, completed in association with partner organisations. The Safer Motherhood Innovation Project started in collaboration with ADRA Nepal in six districts. Based on survey findings, the Health Improvement Programme explicitly focuses on assisting disadvantaged groups.

Security remains a major problem: Kathmandu blockaded for a week. BNMT assists the UK’s Department for International Development with an Immediate Action Programme to bring essential drugs and some reconstruction of clinics to districts affected by the conflict.

2005 – A mid-term evaluation of the Safer Motherhood project finds increased awareness of maternity problems and distribution of home delivery kits amongst mothers, but notes an insufficient supply of trained health post staff. Responsibility for implementation of TB control services is handed over to district health authorities. Survey on access to and uptake of services related to HIV highlights need for harm reduction services and attention to stigma and discrimination. Friends of BNMT a Nepal-based group begin to meet on a periodic basis to provide advice and support to BNMT’s CEO.

King Gyanendra dismisses the government, declares a state of emergency and assumes direct power. A government attempt to impose a “Code of Conduct” to control the activities of International NGOs is met with universal condemnation. Student and public opposition to the King’s rule leads to increasing strikes and public protest. Maoists announce a ceasefire prior to the Dasain/Tihar Holidays and join the major political parties with 12 point plan to restore democracy.

2006 – Following a mid-term assessment of BNMT’s five-year plan, operations are re-established in Biratnagar, with the Kathmandu office retained for networking and advocacy. The programme is scaled-back to 8 districts; and district-level offices are bolstered to support partners in their organizational development. TB control activities focus on quality assurance and training with safer motherhood emphasizing training and community awareness. The Biratnagar-based regional drug store is handed over to a local NGO. Focus for monitoring and evaluation shifts from activity to come. Friends of BNMT , becomes an ad hoc committee of BNMT’s Board of Directors, is expanded, and begins meeting on a regular basis. Following an international search, BNMT appoints its second CEO, Dr. Anil Subedi.

A Maoist-opposition alliance call off weeks of strikes and protests after the King agrees to reinstate parliament. The Maoist initiated ceasefire continues. Parliament curtails the King’s political powers, including his command over the army. An agreement is reached to bring the Maoists into an interim government and the government and Maoists sign a peace accord raising hopes of a durable peace at last.

2007 – Nepal’s fragile peace holds, though ongoing “challenges” include difficulty in accommodating Maoist demands in the interim government and civil strife in Eastern Nepal. Towards the end of the year, agreement is reached to abolish the monarchy with “His Majesty’s Government” becoming “Government of Nepal.”

BNMT begins an exploration of how it might align its next programme during the strategic period of 2009-2014. Focus centres on consideration of the underlying determinants of health status including nutrition, food security and livelihoods, a logical extension of BNMT’s current rights-based programme. BNMT serves as lead organisation on a consortia project, funded by the European Union, to foster the health and livelihoods of conflict affected people.

BNMT moves forward with strengthening the Nepali voice in governance by voting that the organization’s chief executive become a trustee ex officio. BNMT kicks-off its 40th anniversary with Dr. Gillian Holdsworth’s Noble Trans-Himalayan Trek in which she and fellow intrepids walk the full length of Nepal-more than 1000 kilometres-between September and November.

2008 – BNMT identifies its programme focus areas as i. tuberculosis; ii. reproductive health and safe motherhood; iii. HIV/AIDS and sexually transmitted infections; iv. infectious diseases (acute respiratory infections, diarrhoeal diseases, malaria and kala-azar) and v. statutory health needs and livelihood enhancement. BNMT’s programmes operate in eight most deprived districts in the Eastern Development Region of Nepal: Khotang, Sankhuwasabha, Morang, Dhankuta, Ilam, Panchthar, Siraha and Saptari. In addition, BNMT continues to strengthen the capacity of the Basic Health Service to manage TB control.

Nepal is declared a Federal Republic by the Constituent Assembly.

2009 – Co-Directors, Dr Bhanu Niraula (Program and Operations) and Sadhana Shrestha (External Relations) join BNMT in October 2009. The Interim Administrator, Shanta Laxmi Shrestha leaves to purse further studies.

A new strategy for 2009 – 2013 is drawn up in consultation with staff and senior management team. Programme delivery is focused on adapting to meet the changes of a New Nepal. Major accomplishments during the year include establishment of 65 TB Treatment Centres within existing health institutions, 18 health camps, training courses for health service staff and community health volunteers and livelihood related training for 850 individuals.

2010 – BNMT plays a key role in assisting the Nepal National TB Program (NTP) to seek funds from the Global Fund for HIV/AIDS, TB and Malaria (GFATM). After funds are secured, BNMT becomes a Sub-Recipient fir implementation of the TB Program in Nepal and continues to work with various stakeholders in this regard.

2011 – Shobhana G. Pradhan joins BNMT as the New Director in September 2011

Start of the Human Resources for Health Project (HRH) with co-funding from the European Union in February 2011. Implemented across 10 districts across the country, the three-year project is aimed towards increasing the commitment of Nepal’s policy and decision makers to address the disparities in Human Resources for Health. Programme focus gradually broadened other areas such as climate change, peace building, livelihoods and nutrition. Smaller new initatives on Climate Change and Nutrition initiated.

The Constituent Assembly fails to meet the 28 May deadline for drawing up a new permanent constitution.

BNMT Nepal formally registered in Nepal.

2012 – Active case finding through contact tracing initiated in 9 districts of Nepal through the TB REACH project. The approach proves widely successful and the project is expanded to 15 districts in the following year. The Rights Based Approach towards addressing HIV/AIDS programme is expanded to the Mid-Western Region.

At the end of 2012, BNMT’s programmes are implemented in 45 districts across the country. Through 5 projects, BNMT is able to reach 26,587 individuals in 4.431 households.

First Constituent Assembly dissolved on 27 May 2012 having failed to deliver a new Constitution.

2013 – BNMT celebrates 45 years in Nepal. Birat Nepal Medical Trust (BNMT Nepal) established and registered in Nepal.  The Nepali NGO will be responsible for programme implementation at the community level on behalf of the Britain Nepal Medical Trust.

Through the Human Resources for Health Project, 20 Youth Information Centres (YICs) are established in 10 districts. These centres provide information, counselling and referral services for adolescent and slightly older youth.
The Nepal National TB Program in its national strategy adopts the highly successful active case finding approach introduced by BNMT through the TB REACH Project.

Second Constituent Assembly elections held in November 2013. The vote was repeatedly delayed, having previously been planned for 22 November 2012 following the dissolution of the First Constituent Assembly but put off by the election commission. The Nepali Congress emerges as the largest party in the secondNepalese Constituent Assembly, winning 196 of the 575 elected seats.

2014 – New strategic Direction of BNMT for 2014 – 2019 is drawn up in collaboration with the National NGO, staff and shared with major stakeholders. The new strategy focuses on addressing the issues of health and its social determinants. BNMT renews its five-year partnership agreement with the Government of Nepal through the Social Welfare Council.

The TB REACH approach is shared and presented in national and international forums mainly the IUATLD, TB REACH M&E workshop and the South East Asian Regional TB Conference. Research paper on Smoking Cessation published in the Journal of the International Union on TB and Lung Disease.

In collaboration with DFID and the British Embassy, BNMT launches the Health Link initiative (healthlink.org), which seeks to enhance links in the health sector between Nepal and the United Kingdom.

2015 – 2017

After the earthquake of April 2015, BNMT Nepal came upfront to support Community Focused Response and Relief Initiative in close coordination with the Government of Nepal in the earthquake affected districts, Kathmandu, Bhaktapur, Makwanpur, Sindhupalchowk, and Nuwakot.

Initiation of the Post-Earthquake Management Initiative – community Psychosocial Support Services and counselling; construction of gender friendly community toilets in the earthquake affected areas of Kathmandu and Bhaktapur, Nuwakot.

Health system Strengthening – Reconstruction of prefabricated health facilities and supply of medical equipments in the earthquake affected remote villages of Makwanpur district namely Tistung, Makwanpurgadi, Fakhel, Nibuwatar in the first phase and continuation in Khairang, Basamadi and Dhiyal in phase II.

Community interventions related to mental and psychosocial health (MHPSS) and water sanitation and hygiene (WASH) begin. Establishment of MHPSS help desks, Capacity enhancement to health and non-health workers on MHPSS, WASH, MHPSS and WASH awareness programs are held.

Initiation of Disaster Risk Reduction (DRR) intervention targeted to health workers and HFOMC members including the newly elected government leaders of the VDCs. The DRR intervention focus on training on Disaster Risk Management, Mass Casualty Management (MCM) and disease outbreak and health response plan. The interventions run in 7 VDCs (now rural municipalities) of Makwanpur namely Tistung, Nibuwatar, Makwanpurgadi, Phakhel, Basamadi, Khairang and Dhiyal.

2016 – 2019

Interventions to BEAT TB – Interventions in support of the END TB Strategy begin, with intensified early detection of TB cases and supporting all patients to complete their treatment through TB REACH, National Tuberculosis Program, IMPACT TB.

Procurement and installation of GeneXpert machines begin to support early detection of TB in hard to reach areas, reduce the diagnostic delay and enhance the diagnostic capacity though advanced technology.

Until this day, 11 GeneXpert Machines have been installed with government partnership.

Drones and MERMS – Procurement of drones and MERMS for early and rapid diagnosis of new TB cases to support overcoming the access barrier in remote geographically isolated areas of Pyuthan district and improve treatment dherence/patient compliance

Breaking the Silence on SRHR – Initiation of Sexual and Reproductive Health and Rights (SRHR) project to improve sexual health of young people by improving their knowledge on SRHR and advocating for their rights through capacity building of local civil society organizations.