Three years ago, 24-year-old Kamala Gharti of Jhimpe in Chhatreshwori Rural Municipality, Salyan, gave birth to her first child at home. Two weeks ago, she delivered her second child at Salyan District Hospital.

“When I was pregnant the first time around, there were no ambulance services in our village,” she said. “We didn’t have access to health services either. But in the last two years, the local unit has ensured easy access to health services for those of us in rural areas. This made it possible for me to deliver my second baby at a hospital.”

Like Chhatreshwori Rural Municipality, several local units in Salyan and Rukum (West) have expanded health facilities in recent years targeting rural populations. They have prioritised enhancing the institutional capacity of health facilities and providing ambulance services to their rural population. This has helped pregnant women from far-flung villages to opt for safe delivery at health institutions, says Gharti.

Jhimpe is around 15 kilometres from the district hospital in Salyan.

“One had to walk for hours to reach a hospital in the past, as there were no ambulance facilities. Most of the women in rural areas had unsafe delivery. That is no longer the case now,” said Gharti.

Eight of the 10 local bodies in Salyan have arranged for ambulance services in rural areas.

According to the District Health Office in Salyan, there were only six ambulances belonging to the District Hospital, Nepal Red Cross Society and private hospitals in the district two years ago. Eight local units purchased 11 vehicles and initiated ambulance services in the last fiscal year. According to health workers, the operation of ambulance services by the local bodies increased people’s access to health facilities.

The data available at the health office shows that 3,769 women had safe deliveries in 41 different health facilities across the district in the fiscal year 2019/20.

“It is around 63 percent of the total delivery cases in the district. The safe delivery rate will certainly continue to increase in the current fiscal year with easy access to health facilities and ambulance services,” said Khemraj DC, the information officer at the health office. According to him, the safe delivery rate was 53 percent in the fiscal year 2018/19.

The district hospital, two private hospitals, two primary health centres and 36 birthing centres set up at various health posts in the district have been providing safe delivery services in Salyan.

“The number of patients visiting the district hospital has also increased after the local units started ambulance services. We are also developing necessary infrastructures and installing equipment in the hospital to cater to more patients,” said DC.

Almost all the villages in Salyan are now connected with road networks.

“The villagers can use ambulance services whenever needed. In the past, we had to take the patients to hospitals using bamboo baskets and stretchers. Many patients died on the way,” Narayan Gharti of Kalimati Rural Municipality-4 told the Post.

Chhatreswori Rural Municipality had purchased four ambulances and handed them over to the local health posts in wards 2, 4, 5 and 6.

“We have allocated Rs 4.5 million to buy four more vehicles for ambulance services in the current fiscal year. Nobody will die for want of treatment in the villages now,” said Santosh KC, the chairman of Chhatreshwori.

The local units have not only initiated ambulance services but they have also managed the service in an effective way.

“We provide free ambulance services to the poor based on the recommendation of the ward office. Pregnant women and senior citizens get 25 and 10 percent discount respectively while using the service in our local unit,” said Chintamani Regmi, the chief administrative officer of Siddakumakha Rural Municipality.

In Rukum (West), the local units have set up hospitals in their own initiatives to provide health services to people in rural areas. Four local bodies—Aathbiskot, Chaurjahari, Sanibheri and Tribeni—have established their own hospitals in the past two years. Musikot Municipality, which lies in the district headquarters, has the district hospital and four private hospitals. Of the total six local units in Rukum (West), only Baphikot Rural Municipality does not have its own hospital.

Aathbiskot Municipality first established its hospital in 2018. It upgraded a health post in Radi as the municipal hospital.

“The locals have been receiving treatment at the 25-bed hospital for the past two years,” said Mayor Gorkha Bahadur KC. According to Maniraj Shah, the chief at the hospital, around 100 people visit the health institution on a daily basis.

The municipal hospital in Aathbiskot has a laboratory, pharmacy, maternity ward and ultrasound facilities.