The Community Development and Health Project (CDHP) of UMN has worked in Lalitpur District for many years. In 1984, after the opening of the UMN-supported Patan Hospital, a baseline survey was conducted by CDHP within the project area.

This formed the basis for a more focused approach to urban health care beginning in that year in one ward and expanding by 1997 into eight wards.

In recognition of the considerable differences between appropriate urban and rural health and development strategies, the CDHP made a transition into a full urban programme by mid 1997. The programme focuses on improving all aspects of human health and works with the Community so that each member has the opportunity to live in a socially integrated community.

CHDP continues to emphasize training of communities and UMN’s own staff, and on being an innovative model providing good training experience for workers of various outside agencies and schools. In addition, with the successful career development of key Nepali staff, transition from expatriate leadership and a strong career administration has accelerated and will continue in the coming years. A long-term system of Primary Health Care is under development, focussing on essential health care, safe water supply, environment hygiene and sanitation, and basic education.

Due to intervention in several inter-related areas, marked improvements have been achieved in the health and education status of the population. For example 96% of the population has been provided with private sanitary toilets, communal wells have been cleaned, repaired and rehabilitated, providing safe drinking water in accordance with WHO water quality guidelines. Health education and awareness raising activities for targeted vulnerable groups, led to a significant reduction of preventable diseases, like in the case of polio immunization which reached as high as 93%.

• CHDP is currently moving from a heavy involvement in provision of complex services using many skilled people to a more facilitative, supporting and consultative programme with fewer staff. The most important partners are the community groups which have been associated for a long time ensuring continuity, as opposed to District Health Officers, who are subject to frequent transfers.

• The water and environmental sanitation sector proved to be expensive. For long term-sustainability, emphasis must be placed on follow-up and support of water volunteers and pump maintenance teams.

• Regarding the Non-Formal and Community Health Education Programme, this is a continuous challenge and never easy as classes are at unsociable hours and meeting places are hard to find (overcrowded area). Specifically, women have difficulty in making time to attend.
  Replicable strategies for improving urban health in the Nepal context are developed and implemented.