Situational Description:
Nepal is a land-locked developing country in Southeast Asia with a
population of approximately 29.8 million. Around the country, thousands of
population still relies on unimproved sources for drinking water. It is
reported that 49 % of the total population opt for open defecation, more so in
the rural areas (57 %). Only 17 % of populations have sewage connection in
urban areas, whereas it is almost non – existent in rural areas. One such district would be "Jajarkot" as an example.
“Tragedy called Jajarkot”
Jajarkot
is one of the hilly districts of Bheri Zone in Mid-western Region of Nepal.
Khalanga is it’s headquarter. It has 29 village development committee (VDCs).
Each VDC has 9 wards which are the smallest geographical units. The total
population was 1,34,868 (CBS 2001). Now, the expected population nears 1,51,511
(2009). This district is a confluence of people with different cultural
background inter twined with various faiths from majority Hindu population to
some who have faith in traditional healers. Jajarkot is also one of the districts
in the bottom list with low Human Developmental Index in the country. The poorest people, considered “untouchables”
often live in the worst environments, crowded together, lacking adequate
shelter, do not have clean water or sanitation, and suffer malnutrition—ideal
circumstances for infectious disease transmission. This is the district where
thousands of people suffered from cholera outbreak and even hundreds of people died
in the year 2009 and 2010.
Key problems to be addressed:
1. Cholera along with other water borne illnesses is endemic in Nepal. Disease outbreaks
affect different parts of the country almost every year during August – October.
2. Since for example cholera has propensity to cause outbreaks and ability to rapidly lead to death, if therapy is not initiated immediately. This disease has caused fear in the communities that are and were affected in the past and present. While individual households are burdened by the costs of taking care of the sick, the impact of cholera and similar illnesses in the economy of the state is tremendous. Direct costs due to hospitalization and preventive care to be incurred by the state during epidemic would be huge in amount, while at the same time, it may hit hard the tourism and food industry.
The
strategic approach & theoretical basis to solve the problem:
We may
apply ecological model here. This model focuses on the individual and the socio
- cultural surroundings and environmental factors as the targets for any interventions.
People become proactive towards healthy behavior, provided environment and
policy support healthy lifestyle. It usually takes the combination of both
individual – level and environmental / policy – level interventions to achieve
visible changes in health behavior.
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Table. 1 An Ecological perspective: Levels of Influence on human
behavior
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Concept
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Definition
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Intrapersonal Level
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Individual characteristics that influence
behavior, such as knowledge, attitude, beliefs and personality traits
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Interpersonal Level
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Interpersonal processes and primary groups,
including family, friends and peers that provide social identity, support and
role definition
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Community Level
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Institutional factors
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Rules, regulations, policies, and informal
structures, which may constrain or promote recommended behaviors
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Community factors
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Social networks and norms, or standards, which
exists as formal or informal among individuals, groups and organization
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Public policy
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Local. State and federal policies and laws that
regulate or support healthy actions and practices for disease prevention,
early detection, control and management
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Source: Karen
Glanz, Theory at Glance: A Guide for Health Education Practice, 2nd
Edition
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