Monday, June 24, 2013

Thank you for (not) smoking: Bhagyashwar’s Smoke-Free celebration

Earlier this week the GROW team arrived at the office to discover an invitation had been delivered from the Bhagyashwar VDC to the country director, Stephen Petersen, to attend a ceremony celebrating this districts most recent accomplishment. Bhagyashwar has recently gone “smoke-free”, meaning that every household in their VDC (Village Development Committee) has adopted an improved cookstove. As this was a good chance to go into the surrounding community, the GROW team set off with one of the community health employees, Nirajan, to Bhagyashwar, slightly more than a half hour away.

On the way, Nirajan gave us an overview about the VDC and the ceremony. Bhagyashwar is one of the smallest of the 75 VDCs in Achham, but has an overall higher socio-economic status. Seeking to be a model VDC, Bhagyashwar has implemented several government programs. In addition to going smoke-free (100% improved cookstove implementation), Bhagyashwar is also open-defecation free (toilets installed for every household) and chaupadi-free (an end to the practice of separating women on their period, often in poor, unhygienic conditions).

The adoption of multiple voluntary government programs is more than just the fulfillment of a statistic as the community adopts them with long-term health impacts in mind. For example, the chief causes of under-five mortality in the region are pneumonia and diarrheal diseases. The open-defecation free policy, implemented earlier, has already begun to put a dent in that rate. Additionally, the elimination of chaupadi will hopefully reduce maternal mortality as it is high in part because of STIs (sexually-transmitted infections) and UTIs (urinary-tract infections), both of which are due in part to poor menstrual hygiene. And since the cause of most COPD (chronic obstructive pulmonary disease) cases are a result of the smoke from indoor cookstoves, it is hoped that the implementation of improved cookstoves will reduce the incidence of COPD in the region.

Of course, such programs can only have an effect if they are maintained over a long period of time, and they can only be maintained if the VDC is engaged in the program. In Bhagyashwar, the VDC committee organized the stove initiative, and has taken responsibility for its monitoring and followup. If the improved cookstove program expands to other VDCs, there must be a body to maintain their use so that they do not break down with nobody to repair them. When interventions such as these are left without support they become yet another useless relic of NGO subsidies.

On the way back, Nirajan told us that things are already much better than five years ago. People used to go to traditional healers, but now they come to places like Bayalpata Hospital and the local government health posts. Even the traditional healers in the region sometimes refer patients to Bayalpata Hospital. The people of this region, according to Nirajan, have become more sensitized to their health issues. Bhagyashwar saw an opportunity to use an NGO’s subsidies to improve their own health. While nobody can say for certain how this program and others like it will turn out five or ten years down the road, if the VDCs are aware of and want to improve their health, then the smoke-free program and others like it will make a real difference to the long-term health of the people of Achham. 


  1. Hey Greg! Wow, this is so cool! I have never heard of a VDC or anything like that. It seems like a great way to implement and execute health initiatives, and it sounds like it has been effective. Is the VDC part of the government, or is it run by others (NGO?)? Just wondering how they're able to get people to actually listen to them! Haha, anyway, thanks for posting and enjoy the remainder of GROW. -- Emily (GlobeMed at Duke)

  2. Hi Emily! VDC stands for Village development committee, and it's one of the ways the Nepali government is trying to interact with the local communities. There are many VDCs in each district, such as Achham, and the VDCs can be divided furthermore into wards. The committee itself is made up of people who live there, and it is in charge of managing things like education, water supply, health, etc. You can sort of think of it like a Town Council in the U.S. The positions are elected (mostly), so I guess people will listen to the people they vote for :). The health initiatives such as smoke-free and chaupadi-free are run on the VDC level, not the district level, so it's up to individual communities to decide to implement the health initiatives, and they have to want to implement it for it to happen. While the VDC system is primarily based with the Nepali government, NGOs have found it useful to implement programs on the VDC level as well, because of its population size and also for the community engagement.

    Hope that helps,