30. Case 3:

In March 2008, a Biswakarma woman of Shirsa Dadeldhura started labour pain in the night and jethani deurani (husband's elder and younger brothers' wives) women in the neighborhood gathered to support her. The labour prolonged for the whole day without delivery, so they asked the husband to take her to hospital. Instead, he scolded and even attacked to beat them. But they ran away. Later in the night, the women called the TBA who pulled the baby out and cut the umbilical cord with a blade. The mother's body was swollen after 2-3 days but she was not taken to the hospital, the TBA gave her local medicine. As of luck, she recovered and the TBA was rewarded with a khasi (male goat) worth Rs. 2000 (US$ 31 apprx.). This family is illiterate and poor. This is his second wife. His first wife ran away because he tortured her all the time. He used to force her to work transporting soil while she was pregnant. Due to this, she miscarriaged a baby boy but he accused her killing his son and chased her away from home. He was intoxicated all day. He never allowed his wife to go in public and group meetings. If she does, he scolds and beats after she returns home.

As reported in the Case 1, and 2, the in-laws are conservative letting their daughter-in-laws to go for care seeking including husbands (Case 3). Power with seeking care is most important among women but still lag far behind. The 'collective power' gained from the mothers group is proving the best with the initiation of the projects in the communities. As one KI from Chitwan gives example saying - 'A strict mother-in-law, especially Brahmin/Chhetri, tells her daughter-in-law do heavy work as it keeps fit to the pregnant women and would be easier to deliver. Her mother-in-law will scold her otherwise saying' - "Why are you pretending? Are you the only one who has been pregnant? We also had nine or ten babies. If I had shared such problems with others, everyone would laugh at me."

The mother-in-laws mostly control their daughter-in-laws freedom. This trend may have been happened from generation to generation. Because of this, each of the in-law wants to control her daughter-in-law as she was controlled by her in-law (Case 4).

29. Seeking care

Women in the study areas can not decide on their own to go to health facilities. They have to seek permission from their husband if they live in a nuclear family and to their in-laws if they stay in a joint family. In the terai communities women have to seek permission from their father-in-laws. In some cases, not only the in-laws but their husbands also resist it (Case 3).

28. Physical control and privacy

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27. Case 2:

Dilu Rawal of Paduka, Dailekh lived with her Sasu (mother-in-law) and Jethani (husband's sister-in-law) since her husband went to work in India. Dilu's family had some land but not enough to support the family needs because of this, her husband went to India. Dilu was pregnant for three months when her husband left for India. After her husband left, she was treated badly by her mother-in-law. She was not given enough food to eat which resulted to become anaemic. Noticing this, her mother-in-law used to tell lies to the neighbours saying that Dilu did not like to eat and always vomits. In reality her mother-in-law did not like her, therefore she treated her badly. There was no one to take care and love her. Finally, Dilu delivered the baby at home but died after three days. Her husband returned from India and married another woman.

Women need nutritious food in pregnancy. But in mose cases, this does not happen. Although they cook and serve, the priority is to serve the in-laws, children and other men. They have to eat the left overs which is often cold and unhealthy.  Although they need extra food for the sake of foetus inside, they eat less in most cases.

People in terai communities pay groom price known as Tilak before marrying a girl. They rates are normally determined by a bargain subject to qualification of a groom. Doctors, engineers are the most preferred and paid accordingly. This is done secretly in cash. If the bride's parents pay higher Tilak then her status is higher in husband's home though she has no control over the payment the family received.  On the other hand in hills, Daijo (dowry) normally given to a bride by her parents in cash or kinds like jewelleries, livestock units, utensils and even land. Both Tilak and Daijo consider women as a trade item. In both systems, womens' position and their control over the resources are weak and subjugated.

27. Case 2:

Dilu Rawal of Paduka, Dailekh lived with her Sasu (mother-in-law) and Jethani (husband's sister-in-law) since her husband went to work in India. Dilu's family had some land but not enough to support the family needs because of this, her husband went to India. Dilu was pregnant for three months when her husband left for India. After her husband left, she was treated badly by her mother-in-law. She was not given enough food to eat which resulted to become anaemic. Noticing this, her mother-in-law used to tell lies to the neighbours saying that Dilu did not like to eat and always vomits. In reality her mother-in-law did not like her, therefore she treated her badly. There was no one to take care and love her. Finally, Dilu delivered the baby at home but died after three days. Her husband returned from India and married another woman.

Women need nutritious food in pregnancy. But in mose cases, this does not happen. Although they cook and serve, the priority is to serve the in-laws, children and other men. They have to eat the left overs which is often cold and unhealthy.  Although they need extra food for the sake of foetus inside, they eat less in most cases.

People in terai communities pay groom price known as Tilak before marrying a girl. They rates are normally determined by a bargain subject to qualification of a groom. Doctors, engineers are the most preferred and paid accordingly. This is done secretly in cash. If the bride's parents pay higher Tilak then her status is higher in husband's home though she has no control over the payment the family received.  On the other hand in hills, Daijo (dowry) normally given to a bride by her parents in cash or kinds like jewelleries, livestock units, utensils and even land. Both Tilak and Daijo consider women as a trade item. In both systems, womens' position and their control over the resources are weak and subjugated.

26. Resource control

Educated and working women are well respected and can make decision on household and community but in most cases they have to consult their husbands or in-laws before reaching to a final decision. The male members should be consulted because they generate or own resources to meet the household needs. It was widely reported that women having Pewa (private property) in hill communities particularly Magars and Gurungs, can influence in the decision making. In contrast, uneducated women completely dependent on the in-laws and absentee husband's patriarchal property live worst of all (Case 2).

25. Case 1:

Sita Bhandari belongs to a Chhetri family of Paduka 9, Dailekh. Sita lives with her in-laws and her husband is away to work in India. Her family is very poor. She was pregnant for the first time but without any rest. Sita never asked permission to go for check up her pregnancy, nor took iron tablets. This was because she had a fear (dar) and laj (shame) and her mother-in-law was always negative and would never let her go for check up because she had heard telling others that she had delivered many babies without a test, how come these daughter-in-laws need such check ups. When the delivery date reached, labour pain started and that lasted for 12 days without delivery. At last, the family decided to take her to the PHC. The villagers arranged men to carry her in stretcher. On the way to PHC, someone discovered baby's hand visible and they called local TBA for help. The TBA tried very hard to deliver the baby but failed. Rather she detached baby's hand out. Sita was extremely tired but survived. She is still not well but surviving.

Many women like Sita can not ask and go for regular check-ups due to dar (fear) and laj (shame). Had her husband been at home, we could assume that she could have gone for check up with him but without a man's presence she was powerless and helpless. Similar state of 'culture of silence' was reported by Pradhan (2005) that is considered as an important factor in women's failure to access health care.

There are many proverbs and idioms that reflect the situation of suppressed and poor women. If women talk big about development and rights they say Pothi baseko (hen is crowing), Neta bhaki (what a surprise she is becoming a leader…).  For instance, Aaimaiko baat, kukurko laat (women's speech, dog's kick), Aaimaile kateko bato chiplo (women constructed road are slippery), Marda ko duswati (A brave man's ten wives), Namardako swasni hunu bhanda mardako susare hunu niko (Its better to be a mistress of a brave man than to be a wife of a coward). There are some of the proverbs that portray the womens's lives in rural villages of Nepal.

24. Freedom of expression

Expressing feelings and thoughts are some of the major features of freedom. A woman's independence and her freedom can be judged the way she express herself. In the study areas, women were found living in silence although they desire to express their opinions. They can not easily tell their in-laws about first pregnancy, menstruation, sickness, forced sex by their husbands, seeking permission to go to Maiti (maternal home). They always have a kind of fear (dar) and feel shy (laj) to tell such things even to their family members. Dar rakhnu (fearing) is an established psyche among Nepali women to do or act on anything against the established norms. There are many proverbs and idioms which are based on this. It is not the law but the norms that binds Nepali society. The laj (shame) binds to keep women from exposure to others. The third term ijjat (prestige) is more important to justify an individual's personality and evaluate the respect in the community.

Several KIs across the districts reported that many women do not tell their gynaecological problems to their husbands and in-laws due to laj. As a result many cases turn into serious sickness and prove to be fatal (Case 1).

23. Decision making

Decision making process in seeking care is yet a matter of exploration. As Miller (1990) observed a wider consultation of the family members in agricultural related decision making in meal time by the head of the households and announced the final decision by the head. Whereas decision related to women's reproductive health is rather private and secret, so one can not expect a wider discussion due to fear (dar), shame (laj) and prestige (ijjat)

Some women can decide what to cook but none can decide when and where to seek health care if the male members or in-laws are there. They have to seek permission from their husband or mother-in-laws. Women are taken to the health facilities as far as possible by their husbands if they live in a nuclear family. Women can only decide when their husbands are away. Although all sources of power are important, women are mostly deprived of the two major sources of power i.e. intellectual and financial. Their subordination starts from this stage because they have to rely on their husband's patriarchal resources i.e. husband's inherited property. They are less educated and culturally they have to honour their husbands as god. Because of these two reasons the subordination of women is deep-rooted in Nepali society, irrespective of location and communities. The practice is more pronounced in the terai than in the hills. This is one of the main reasons why Nepali women delay to seek health care facilities.

22. Power relations

Women are caged, mechanised and in subordinated state in the study areas. From the field work, it was clear that the women do not enjoy any sources of power namely – physical, intellectual, financial, spiritual or collective power. Because of their weaker positions, women lead a miserable life and are in highly marginalized and disadvantaged state of safe motherhood. Womens' movements are traditionally restricted. They work as labourers in all parts of rural Nepal i.e. either in the house or in the farmland. Both household work and farm work are their daily chores. They are disgustingly treated as sex toys who ultimately become as reproductive machines in each family. The reproductive roles tend to force them to reproduce another unit of family without any plans for birthing. Any woman in her household can not decide on her own, if a grown up male member is present be that a father-in-law, husband or even a son. Woman's power is associated with her husband's personality. Nobody seriously treat a woman's concern if her husband is away from home or dead.

21. Situation of women

The overall situation of women particularly the poorest and excluded women are portrayed under power relations, engagement and participation, knowledge and practices of safe motherhood. This explains their situation in terms of power and decision making to access to the services. In addition, this reflects their knowledge and practices and preferences over the services they receive.

20. Analysis and interpretation

This report is the product of voices of service receivers and providers in the eight districts of Nepal. The collected information was analysed using different qualitative methods. In addition to the field information, several published and unpublished literature were reviewed. In addition, related websites, news on daily and weekly papers and magazines were also reviewed and incorporated as thought appropriate.

The IDI and CEIs were plotted into a matrix. The information provided by a respondent were tabulated and analysed to summarise the total information from the respondent. At the end of the each respondent's interview, the enumerator wrote notes on her/his comments about the respondent. That supported to conclude the research in a logical way.

In the KIM, the DFs immediately transcribed information provided by the KIs in the debriefing sessions. They were fairly edited and typed by the respective facilitators. After transcription, the PCs collated all information into an analysis framework. A two day workshop helped the facilitators to do this. The analysis framework helped the PCs to prepare district level reports.

Each district facilitator prepared at least five relevant and meaningful case studies. The PCs read and commented on the cases and forwarded to the consultant. The relevant cases were used to support the information obtained from other tools such as IDI, CEI and the KIM. In addition, there were many additional cases recorded in the course of KIM and referred as and when relevant. Although only few comments and suggestions were received in the boxes, the suggestions were real and genuine to supplement the analysis and interpretation of the data.

All analysis and interpretation were based on the information obtained from the field work of IDI, CEI, KIM, case studies and suggestion boxes. Field visits, observations, discussions with the key people during the course of the meeting, workshops and training helped to formulate more concrete ideas on the issues. All analysis was done anonymously and all cited names were changed on the ethical ground.

19. Limitations

Field work

One of the major limitations of the voice capturing was following the planned schedules since the country was passing through political turbulence particularly strikes and blockades in the terai forced us to reschedule the activities for several times. Because of this, the KIM activities had to be conducted in the middle of cultivation season i.e. June to August in both hills and plains. In some cases, the KIs complained about the time as they had to hire a labour to complete the farm work. This might have affected the level and quality of debriefing information in the KIM. Secondly, some of the  IDIs could not be administered as planned because the planned respondents positions were fallen vacant for several months and years. In some cases in the CEIs, the service receivers did not want to attend interviews as they were hurry going home. For CAC patients the matter was private for them. Furthermore, the suggestion boxes were newly installed and not many people were aware of the purpose. Also health facility staffs were not fully convinced about the use of the suggestion boxes. As a result, only few suggestions were received in the boxes.

Level of generalizations

Since the ground of the data is rich, the consultant has tried his best to analyse and synthesise this report on three dimensions. First of all, the data were collated at the district level while preparing each district reports. The PCs have collated the data and prepared a district level report of each for district level sharing. Secondly, information from each voice collection tools were examined and collated by individual tools with the help of cross tabulation. This has helped to analyse the collected data in a deeper length. Thirdly, the analysis were supplemented by the consultants field notes and case studies prepared while visiting the sites to support the PCs and DFs. Despite all these, the level of analysis at district level may have been limited because of the PCs involvement in other activities of their own organisations. Because of this, the quality may have been affected to a minor extent.

Coordination and cooperation

The VCOs were treated as independent organisations, there lacked some cooperation with the district project offices. Because of lack of joint planning between project office and the VCOs, field activities sometimes were clashed and had to be rescheduled. This may have inhibited wider feedback collection in the entire process.

18. Suggestion Boxes

17. Case Studies

Case studies were one of the most powerful tools to collect and supplement the information from other tools. A minimum of five case studies were planned to collect per district and all were completed. There were more cases reported and collected than planned. While in training, it was emphasized to prepare cases of human interest and relevance. The IDI and CEI interviewers did not collect only cases per se, visited the places to note, observe and triangulate the effects as far as possible.  In the KIM tool the cases were noted and reported verbatim as and when told and listed in the debriefings. The VCOs as a part of their progress reporting, frequently reported the cases in their quarterly and half yearly reports. To supplement the information, some of the cases are provided in this report in Italics .

17. Client Exit Interviews

The Client Exit Interviews (CEIs) were conducted to explore and analyse the 'on the spot' understanding, experiences and comments on the services the receivers got. The available services, health staff behaviour, quality, cost and privileges were the main areas of interview. All interviews took place when they were leaving the health facility premises. Altogether 320 service receivers were planned to interview. The interviews were intended among deliveries (18), ante natal care (10), post natal care (7) and comprehensive abortion care (5) from each district whereas the research team was able to interview 316 clients.  The comprehensive abortion care patient could not be available as of target, because some of them wanted to keep their treatment secret and some did not want to respond. The other interviews were short and took about half an hour. Checklist is provided in Annex 5.

Table 3: Proportion of CEI respondents by social groups
Social group	% of CEI respondents	% of Total population
BC	36	35
RAJ	3	5
DAJ	24	30
Dalits	21	12
Other excluded group	11	13
Religious minorities	5	5

Interestingly, the distribution of CEIs fairly represented the percentage of district population (Table 3). The selection of the respondents was random but their representation by social groups appeared to be roughly proportionate except  Dalits and DAJ. The table indicates that the higher proportion of Dalit women came for seeking care against somehow lower proportion of DAJs. This can not be the sole indicator of the care seeking behaviour but helps to understand the visit trend in the local health facilities.

16. In-depth Interviews

The In-depth interview (IDI) was an important tool to enumerate situation of health facilities. They were used to record the feelings, perception, motivation and problems of the service providers. A total of 29 staff in each district, 232 in all districts were planned to interview.  The planned breakdown of the staff in each districts were doctors (3), public health nurse (1), health assistant (3), staff nurse (3), auxiliary health worker (6), assistant nurse midwife (3), maternal child health worker (5), peon (3) and members of the management committee of the facilities (3).  However, a total of 213 (92%) staffs were interviewed towards the end. The lapses occurred due to the specified staff were not available for the interview. In few cases the positions remained vacant and two of the respondents refused to give interview. The IDIs used structured checklists (Annex  4). The major components of the interviews included available services, human resources, tools and equipment, services to improve, community cooperation, awareness of inclusion, security and self respect, level of motivation and satisfaction at work.

Out of 213 service providers interviewed, the highest proportion comprised of Brahmin/Chhetris (63%) against their actual proportion (35%) as of national census 2001, and lowest (1%) comes from the Religious minority groups (Table 2). The reasons of over representation of Brahmin/Chhetris against others are not so specific but their proportion could be higher in the health facility than other social categories. Similarly, the under representation continued in the Disadvantaged Janajatis (DAJ), Other Excluded Groups and Dalits against the proportion of their population in the districts. The selection was random but the proportionate distribution was concentrated towards the Brahmin/Chhentri (BC) and Relatively Advantaged Janajatis (RAJ). The representation may be true but was beyond the scope of this analysis.

15. Key Informant Monitoring

The Key Informant Monitoring (KIM) is an innovative and participatory approach to program monitoring and research. KIM is more than a monitoring tool; it is also a tool for advocacy, participatory planning and empowerment of marginalized group (Hawkins et al, 2004). This is derived from Participatory Ethnographic Evaluation and Research (PEER) where a women member of a community is selected and trained as a Key Informant (KI).  Each KI then is asked to choose two friends among her closest, as the peers of the respondent. Then the KI builds rapport with her peer and requests her to be the informant. Upon the agreement, the KI starts interacting with her peer using 'third person interview techniques', within the themes agreed and provided. The themes, sub-themes and related questions are prepared and practised in the course of training. The interactions mostly begin with stories related to the maternal child health in the community, mostly using 'third person interviews'. The KIs debrief the information to the main researcher in this case the DFs, in a designated time and place. The researcher (DF) notes the key information and prepares a report on it.

In this study, the KIM was the most important tool of the voice capturing in terms of its peer ethnographic orientation of data collection among the peer groups of service receivers. Its anthropological orientation of the data extraction and understanding of the issues gave rich personal and private information to the researchers. The selection and training of local informants gave insightful and meaningful information that an outsider would have never extracted. This tool was tested and proven as one of the best for collecting of the 'voiceless'.  During this research, a five day residential Training of Trainers (ToT) was organised for the District Facilitators (DFs) where they were trained to conduct district level KIM training in their respective districts. The core KIM trainers of Options UK, HICODEF and EAP had facilitated the training. Following the training, the key trainers (DFs) prepared plan of action with agreed criteria to select seven KIs per Village Development Committee (VDC), making 14 KIs in two VDCs per district. This made 112 KIs in eight research districts with a total of 294 respondents. The KIs social groups (as categorised by the Department for International Development (DFID) Nepal are provided in Annex 1 against the actual population are provided in the Table 1.

Looking at the distribution of the KIs, Brahmin/Chhetris, Relatively Advantage Janajatis (RAJs) and Other Excluded groups were slightly under represented whereas Disadvantaged Janajatis (DAJ) and Religious Minorities were over represented. It was believed that the representation of the KIs was the key point to start an authentic voice collection. Viewing fair representation of the poorest and marginalised section of the communities, selection criteria (Annex 2) were set to ensure inclusive KIs in each VDC of the districts. The PC with the coordination of the EAPC and EASOs conducted village level workshops and involved the key actors of the village in KIs selection.  It was interesting to note that the closed society like Religious minorities i.e. Muslims, some Dalits in the terai competed for the position. Some Female Community Health Volunteers (FCHVs) were disappointed for not being selected, as the KIs this time were chosen from the fresh, not from the existing health volunteers.

 Colloquial languages were used while collecting information. The KIs and DFs used local languages namely Tharu, Bhojpuri in the terai, Magar and Doteli dialects in the hills. The information were collected under the agreed three themes, namely – a) Condition and position of a woman in household and community, b) Safe motherhood (pregnancy, delivery, post delivery, neonatal and abortion care) related problems and dangers, and c) Access to and quality of services. Under each theme, their sub-themes and possible questions were worked out and agreed in the training (Annex 3). The KIs were trained in 'third person interview technique' with role plays and drills until they were confident enough to do it in the field. The KIM field work was conducted in three weeks interval in each district starting from first themes followed by debriefing of each KI. Following the KIs training in April-May 2008, the field work took place during June to August 2008. All debriefing notes were transcribed and analysed while preparing the district reports. Please refer to separate Voice Capturing Guidelines for detail process.

14. Voice capturing tools and process

Voice capturing tools were chosen and decided by the project stakeholders (section 1.1). Altogether there were five qualitative tools namely Key Informant Monitoring (KIM), In-depth Interviews (IDIs), Client Exit Interviews (CEIs), Case Studies (CS) and Suggestion Boxes (SBs) employed in the research. They were selected because of the nature of the data required in the voice collection and their proven strengths.

13. Objectives and Methodology of Research

The overall objective of the report is to compile the voices of service receiver and providers in all EAP districts. More specifically the report aims to:

Methodology

The EAP recruited two Non-Governmental Organisations (NGOs) as voice capturing organizations (VCOs). The Himalayan Community Development Forum (HICODEF) based in Nawalparasi (one of the voice districts) is a community and livelihood focused NGOs coordinated and led the voice collection in Morang (terai), Chitwan (inner terai), Parbat (hills) and Myagdi (mountain) districts whereas Social Awareness Centre (SAC) based in Surkhet specializing on livelihood and advocacy took over the responsibility of Nawalparasi (inner terai), Rupandehi (terai), Dadeldhura (hills) and Dailekh (hills). Please refer to the location map (Box 1). It is believed that the selection of eight districts fairly represents the geographical, regional and socio-cultural diversity of Nepal.

These NGOs known as VCOs in this entire report, were hired on the ground that they were the grass root intermediary organisations and easily could reach to the communities where other EAP activities were implemented. Secondly, they were independent organisations and they could collect actual voices of the service providers and receivers without any biases. Since the voices are indifferent and coming from core of the respondents, it required some level of independent interpretation. Most importantly, they were perceived as the third sector organizations so they would rationally disseminate and strongly advocate the voices of the poorest and excluded women through their networks, for policy changes as required.

Both of the VCOs each hired a male Program Coordinator (PC) followed by female District Facilitators (DFs) in their respective districts. The responsibility of the Program Coordinators (PCs) was to plan, coordinate and administer different voice tools, prepare periodic and final reports, plan, coordinate and disseminate the results to the multi-project stakeholders, district government heath facilities, Reproductive Health Coordination Committee (RHCC), a committee formed among district level stakeholders including government, non-government and private parties, local bodies and information providers. The District Facilitators (DFs) collected voice of service receivers through Client Exist Interviews (CEIs), case studies, suggestion boxes. The Key Informants (KIs) using the Key Informant Monitoring (KIM) tool collected stories and voices of their peer groups from the excluded part of the society. In addition, the DFs conducted In-depth Interviews (IDIs) to collect voices of the service providers.

The EAP hired an Anthropologist as a consultant for periodic support to the project. The consultant designed training on CEI, IDIs and case study preparation and trained the DFs to enumerate information from service receivers and providers. The training consisted of theoretical classes with practical exercises in the class and piloting the skills in the respective situations.  The Options UK consultant and a local consultant trained the DF's Training of Trainers (ToT) on the KIM tool. The anthropologist supported the entire research process in all tools including the training, field work planning and implementation, data generation, quality assurance, data analysis and interpretation of the information. In support of the consultant, the VCO PCs prepared eight district level reports of their respective districts sharing and the consultant wrote national level consolidated voice report. In addition, the consultant has prepared a voice capturing guidelines for the EAP, and or any other similar organization, requiring voice capturing process details in future.

12. Background of Research

Voice capturing synonymously used as 'collection' also in this report, is relatively a new concept in right-based approach of development. Some people call it 'voice monitoring' and in this project, it was coined as 'voice monitoring' but while implementing the project, the EAP stakeholders preferred to call it 'voice capturing' instead of monitoring on the ground that this project focuses more on collection of the voices rather than monitoring them.

Voice refers to both capacity of people to express their views and the ways in which they do so through a variety of formal and informal channels and mechanisms. This refers primarily to the efforts of the poor to have their views heard by more powerful decision makers (Goetz and Gaventa, 2001), The terms of reference (ToR) to the voice capturing organisations (VCOs) denote voice capturing as the collection of citizens' voice to the various ways that citizens and organized groups place pressure on service providers and policy makers (this is sometimes referred to as client power) to demand better services. This includes: complaints, protests, lobbying, participating in management committees and existing public services and establishing alternatives. Voice capturing is a concept and process to reveal inherent situation of the voiceless. It is an awareness and demand creation among the stakeholders including the poorest and excluded. It is therefore, voice is a concept; voice is a demand.

Voice capturing is simply understood as collection of a person's aspirations, thoughts, perceptions, outlook, comments, complaints and suggestions of service receivers who are women of mostly reproductive age, and service providers who are community health workers, volunteers, paramedics, nurses, physicians and management committee members. Both parties have expressed their feelings, thoughts and perspectives on the services related to safe motherhood and neo-natal health. It is a process documentation which records major concerns and complaints of the 'service receivers', mostly the women who received services from the health facilities and the 'service providers' who work on behalf of the health facilities. In addition, it has extensively explored and recorded the untold stories, eavesdropping comments and remarks from both the sides.

The rationale of voice capturing was to advocate safe motherhood as the 'rights of women' with the evidences from the ground and ultimately influence on the policy changes at various levels as required. This was an utmost need because despite government's and international agencies' (operating in Nepal) high priority, the maternal and child mortality remains (281 and 33 respectively) one of the highest in the world (MOHP et al, 2007). The death rates are extensively high in the rural and inaccessible areas. Services are scarce in-house and traditional beliefs are strong which restricts to seek care of available facilities. The health care practices are proven wrong because the high percentage of mothers die even after successful deliveries.

More importantly, safe motherhood is a woman's right. There are more than nine conventions and respective declarations on human rights listing to assure the women's reproductive rights. The declarations list that a couple or individuals to enjoy the highest standard of reproductive health; be able to make decisions concerning reproduction free of discrimination, coercion and violence; and decide freely and responsibly the number and spacing of their children, and to have the information and means to do so (Rashid 2005). To assure a woman's reproductive rights, it was an utmost need to record the 'right holders voice' to understand the underpinning issues in it and disseminate them further for advocacy and policy changes in a larger forum.

11. My Research “Voice Capturing”

"Voice Capturing" is one of the components of the Equity and Access Program (EAP) of ActionAid Nepal. This is a multi-stakeholder project among ActionAid Nepal, New Era Limited, Sustainable Safe Motherhood Program (SSMP) of Department for International Development (DFID) UK and Options Consultancy UK. The EAP was launched since February 2006 in eight districts - four terai (plains) and four hills namely in Morang, Chitwan, Nawalparasi, Rupandehi, Parbat, Myagdi, Dailekh and Dadeldhura districts of Nepal. The program aimed to increase knowledge and awareness on Safe Motherhood and Neo-natal Health (SMNH) in community, especially among poor and excluded by creating conducive environment for the poor and excluded women and families by addressing social, cultural, economic and physical barriers. Secondly, it aimed at capacity building of Equity Access Support Organisations (EASOs), local government, Reproductive Health Coordination Committee (RHCC) in the working districts and other community groups to promote equity and access for safe motherhood and neo-natal health. Most importantly, it aimed to capture unheard voices and comments of the service receivers known as the 'right-holders' and service providers as the 'duty bearers'. This report is the product of the last objective of the EAP, mainly focusing on the process and outcome of voice capturing among poorest, disadvantaged and excluded women of Nepal. The voices were collected during October 2007 to September 2008 using several qualitative research tools. This is the second consolidated voice report of the organisation. The first one was produced in August 2007.

10 Value of technical Education

Technical education means having the knowledge of special skill. Technical education teaches us theory and practice. The academic education gives us only theory knowledge. It has no practical applications. Some who has got the technical education call a technician. A technician can use his skill with practically. He can make and repair also.

Technical education helps for the development of nation and reduce the unemployment. It helps progress of a country and it makes self- sufficient. It we have no our own technicians we have bring them from outside and have to pay them a lot of money. If we have no technicians it will very slow to achieve the progress. It take much time.

Our trades, industries, agriculture needs technicians. They use their skills and it will increase the product with quality. It generates the incomes. They can stand own their legs. Nepal like developing country needs a large numbers of technicians. They can change the face of society. They are pillars of development.

One of the reason of slow progress of our country is the neglect of technical education. We have mushroom growth of academic institutions. The products from such types from institutions have knowledge on theoretical but they can’t do practical work.

There are few technical institutions in our country. They are centered at urban area only. It takes long time to establish and need more resources. We have less variety of subject matters. We have to go outside for some technical education. Although, there are start to establish such types of schools from private sectors. But they have many problems. They are more costly. These are running only business propose. So, it is not accessible for all. If we want to get the progress government should manage all technical institutions and

9. Unemployment

Unemployment means lack of work. We often hear of the problem unemployment in Nepal. It is serious social evil. If a lot of people have no job, its effect is bad for a country. A man without job is a burden to others and to nation. If he should maintain a family, the condition is worse to him.

Unemployment leads person to do destructive acts in the society. He may commit to do crimes to live. It has been great problems day by day.  It hampers nation. Society will be imbalanced and will create great problems.  The responsibility of the nation should be solved such types of critical issues. Nation’s resources will diverged at unproductive area instead of invest at development.  

There many people looking for jobs. When youths do not get any jobs, their knowledge, labor and ability is completely useless. This unemployment groups create the conflict at our society. If the people are not busy they will be lazy. Human resources will destroy day by day and it will be useless.

The equal opportunity on the employment is the rights of people. There should not be source force. Now days there are malpractices to get the opportunity. Who has the authority of managing man power they pickup their near persons. He or she gets chance if they are unqualified. Qualified candidates may not get opportunity for the vacant post. This unsystematic process may create more problems in future. These types of human resources do not provide the good services to the nation and people.

Lack of industries and trade, lack of technical skill and knowledge, traditional agricultural system, system of education are the main causes of employment. Use of local resources is also way to solve the unemployment. We are lucky for natural resources but we can’t use. Let’s hope we will use more and more in the future. Because, Nepal has rich with renewable natural resources. It will not finish. It can be use time to time. So all people will be employed if they have hard work and proper use of their time.

8. My first day at collage

When I cross so called Iron Gate, school living certificate, it was interesting to join the collage. I have seen my seniors who were studding at collage and they were looked more independent than school life.  They were use to wear out dress and catching books by bare hand. Some boys had long hair.

I was admitted to this collage in class proficiency certificate level. More than fifty students were new and teachers were new for me. In the first period, an English teacher was come. He asked my name and house. He asked grammar also. I told correctly first answer and second answer was wrong.  All the students were laughed. I became nervous. The teacher advised me to red hard.

This circumstance made me more nervous. I felt uneasy at movement. Any students were gathering around me. My face was red and hot. Because I was from village and there was no quality education. We were read only for pass, not for knowledge. We do not care our study at school level.

Whole day I thought only wrong answer I gave to English teacher. I return to my room and I could not take dinner and sleep also. When I was laying on my bed I did committed for hard work for read.

That was my first day collage. It was bitter at that time but now I thing the day is being valuable for me. I try to do what I thought first day at last.

7. My punctuality

Our life is short. We are human beings. We have to do many works. This short life begins after birth. So, we have to use time wisely. If we use time properly, we can achieve success. Time once gone never comes back. It is said that time and tidy waits for no man. Everything is easy if we are busy.

Time is more valuable then wealth. We must spend it carefully. We must setup the routine and follow it properly. We have to share more time for more important worker and less time for less important works. For example,  a student most give more time for study for more valuable matter to get the success.

It is more important for us to know the valuable works. We can buy every things like blood, books, but we can’t buy time. Time always pass quickly without any rest. We can’t control it. Peoples who spend time on unnecessary talk, gambling may cause of failure in their life. They suffer in their whole life.

We must correct out habit of wasting time from our early stage. Time always moves forward not backward. It can’t be measure by money. The misuse of time resulted darkness our future. Nothing is easy if you are lazy.

Our life is valuable. We have to do a lot of things in this life. Time is valuable as life. It we give important to our life, we have to give importance first to the time. Success depends upon the use of time. The proper use of time really leads to achieve the goals of life. Wasting of time is wasting of our life.

6. Social service

Social service means serving society. It means helping people in troubles. It is also voluntary services also. We do not expect any things in return. But victims, suffered, marginalized who holds the service may change, improved their life.

Social service may consist at various level and types. Such as incensement of economic status, rehabilitation of vulnerable and victims, caring of patents etc are the examples of social services. Social service is much important for the victim people. It saves their lives.

Social service also increases the economic growth also. It may intend to reduce the poverty. Poverty is a major issue over the world. If any family or person is poor, that occurs various problems in their life. Every one can’t gain good education, well treatment, healthy and hygienic food etc.

Poverty is a major issue at present in the world.  So united nation has determined development goal.  This goal known as millennium development goals. There are eight goals and poverty is the first goal. It has defined that poverty is eradicable. If we lunch the common effort to eradicate the poverty it may reduced. But if we target only to reduce the poverty it may not be eradicable.

5. My hobbies

We required rest and recreation in the life. We should have some recreation during the leisure. In the spare hours we do some things for the sake of pleasure. It called hobby. One takes up a hubby not for money, but for pleasure.

There are different kinds of hobbies. One of them is stamp collection. Some persons have photography, some have singing, and dancing etc. some have playing games, some have painting and some want reading extra books.

My hobby is writing stories about the community people. Since the last five years I have written case studies more than hundred. These small stories are really happen at my society. Some articles were published at news paper. It encourage me to be state forward in my hubby.   

Once time I was wrote a case study about the pregnant women who does not want to check up her health. She felt shame to show her abdomen with health worker. Most of women were suffered from this case. Because, there  were male health workers at near health service centre.

When I published this story in a local news paper, immediate health administrator was came in my village and discussed on this issue and local people demanded a female health worker at the service centre. Within a week, a nurse was posted to here.

It made me more encouraging to serve women this way also. My neighbors and colleagues were happy and congratulate me. Sometimes it may create terrible situation also. Thanks to god, still I have not faced misunderstandings.

4. My home

Home denotes the house where one lives with one’s family. It is said there is no place like home. Home is the sweetest place on the earth. No one like to live away from home for a very long time. At home a man has his family who share his joys and sorrows.

My home away from Kathmandu at remote village. We are seven persons at my family. I have my parents, brother and sister. My father and mother are stay at home and rest members are away from occupation. We gather at special occasions. When we meet at home we share about our joys and sorrows  during the out stay.

We have a small but pretty home. It has made of bricks and mud. There are three floors and five rooms. My father and mother use a large room where we also gather usually at morning tea time and evening period. This room is at ground floor. Other rooms are used for bed and rest. Every person has decorated their room by educative and attractive posters and photographs.

Our kitchen is build near the house. Kitchen is situated at proper site. It does not disturb us during working there. It has two mouth smokeless stove and chimney. Chimney through the smoke to outside. Other utensils are kept at proper location. There a dining table and six chairs are stand around it.

There is toilet behind the house with separate bathroom. It has made of bricks, cement and rod. There is water tank on the top of toilet. There is 24 hrs water facilities for bathing and toilet. It does not hamper to us by product gases.

My home environment is very suitable for health. There no noisy, air pollution etc. Our neighbors like much more my house. My neighbors are good. They all are educated and well behave each others. They don’t have any quarrel with them. Most of them have job and rest of are professional farmer. They produce vegetable, rice, wheat and maize.  They are happy and satisfy from their work.

3. An interesting Dream

Some days ago, I had an interesting dream. I shall never forget this dream. I wish dream would continue. If this dream were real, we would happier in life. I do not know come about, but they take us for a short time into a delightful world.

One night, I went to bed with a care-free mind. I had finished my diploma exam. I had done fairly well in all subjects. I dreamed that I have passed the exam. I joined the university to study social science. Sociology and anthology were my favorites subject to serve the poor, marginalized community and nation. I was good student at my class. I secured the first position in the master level exam. It was honored me as gold medal from chancellor of university.

I applied for a scholarship to study for Ph.D. at Oxford University. I was only one scholarship holder from south Asia. I studied there for five years. The record of my study was highly satisfactory. The professors of Oxford University admired my brilliant, intelligence, hard work and laborious study and progress.

I returned to Nepal and was appointed as a chair person of National planning commission. I thought that all my learning, experiences, efficiency would use for my country and Nepalese people. I was driven the national plan as well as modern methodology. I was improved the planning policy, managing resources,   implementing strategies, monitoring and evaluation. After one year, it was seen significant outcome at commission. I handled successfully manage at all segments. Precedent of Nepal highly praised me and awarded me at national level and recommended for novel prize at international circumstance.

After five years, I was joined at United Nation Organization as the general secretary. I was involved and handle the high and superior level conferences of the world. Once time I was invited at a paper presentation program if Africa. When I my plan was landing down at airport it was looked hot.

 Actually at that time I was sweetness and under the heavy blanket. I was return back on real life and get up. It was 5 o clocks in the morning. Really I do not forget this dream. If this dream can convert in my real life it makes a romantic case.