Infant Care Facility Improvement Project

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ICRI-Nepal commenced program through NCPD in 2002 and later worked directly with NCO/Balmandir by signing a separated MOU which was focused at improving physical care facilities and enhancing quality of care for infants 0-6 years in specific.

The key problem of the organization is that the care mothers do not have the ability to meet the emotional and physical needs of so many infants and children. Caregivers have no knowledge of child development and or their own vital role in helping the children’s develop. This results in both physical and emotional suffering of many children on a daily basis. It also results in far too frequent hospitalizations for preventable diseases, delays in cognitive, language and motor skills, and in most extreme cases, death. While the numbers of children who have died while being cared for in the orphanage have been recorded, the full extent of the problem is much graver then we are seeing from outside. ICRI-Nepal commenced with physical improvement of the orphanages in 2004-2008. Also ICRI-Nepal introduced periodic mothers training, orientation and meetings. During this program the care mothers have been given boost to be consistent, devoted and responsive. They were given skills on why infants need proper stimulation of being frequently held, touched, spoken to and interacted with. Older infants also need a clean safe environment that they can explore freely in addition to food, warmth, consistent medical care and clothing.

ICRI-Nepal in collaboration with the central orphanage jointly worked to created sound atmosphere & loving environment for healthy development of infants and children. The state of affairs at the central orphanage used to be antithetical to healthy child development. ICRI-Nepal is not in a position to respond so many problems that have been documented due to funding constraints. The other problems as identified by us are; None of the children receive physical examinations upon arrival, medication is not labeled or chartered and is administered on an inconsistent basis, HIV (Hepatitis) testing is not being done except for those babies who are in the process of being adopted; even some common vaccinations are not being given to protect against preventable diseases. Caregivers are not receiving the appropriate preventive medical screening and treatment so necessary for working with fragile newborns and young children. There are serious concerns about sterilization of bottles and even access to hand washing within the infants’ rooms. All these problems are deeply rooted/related to administration and management as well as basic knowledge and skills for organizational development of the institution.

The key concerns and/or problems as identified and understood by us is that the management does not understand and realize their roles in the central orphanage. Sometime they seem indifferent to the problems, needs and issues because of lack of motivation, lack of organizational plan, lack of periodic and updated training, lack of poor human resource management within the institutional practices. Staff ratio is so high in administration and management (more than needed) whereas the ration is very poor in child care deliver services. It is therefore challenging for the care mothers to respond adequately to the infants needs to be held and comforted when scared, upset or frightened, to have their diapers changed in a timely manner or even to be held when fed. As a result, while the recent to arrive babies cry out to have their needs met, the older one does not. They have learned in their short lives that no one is available to respond. This results in a silence that has been written about in the orphanages in the most poverty-stricken areas of the world.

When children do not have loving relationship with caregivers and when they are not held, talked to, comforted when upset or able to explore their environment they suffer a whole host of consequences. They have diminished intellectual abilities as a result of having less active, smaller brains. Since the brain growth and development is most active in the first three years of life, irrecoverable damage is being done. Infants can be observed to have poor concentration, an inability to regulate their effects, problems forming relationships. They frequently act in a passive manner, engage in self-stimulatory behaviors such as rocking and head banging and develop conduct disorders when older where they show no regards of the feeling for others.

Basically the same holds true for the rest of the older children in the orphanage. They are lacking the individual care, concern and closeness of a family. How can these children be possibly grow up to be confident, contributing member of society? How can these children get what they so desperately need – a parent, family ties, a home community? As reported globally, it is not good to keep children at the institutions, institutions should be the last resort for children to live but in case of the central orphanage it is not possible. 

While the smaller child care group homes have the option of rejecting infants when full, the central orphanage being the largest, oldest and biggest child care home accepts all infants including children below 16 years without regard for either the ability or resources to care for them. The census has increased on a weekly basis and at least count over 50 infants being cared for woefully by few caretakers.

The central orphanage was founded in 1964 under the active initiative of Her Majesty the Queen Mother with a mission to provide shelter and education for the orphaned children. The institution had a reputation as a “temple” for the children until the restoration of democracy in 1990. The institutional faith & credibility has been gradually spiral down because of innumerable reasons that are directly related to administration, management and governance system. There are several hidden “un-identified” “in-under stable” reasons impeding the development of the organization to its full potential. Moreover, this orphanage holds the highest capitol resources, the land, in almost all 75 districts of the country and has been providing shelter to about 450 children of different backgrounds in Nepal. It is visible to almost all sections of the society that the intuition has highly overlooked its institutional values such as: transparency, sustainability, accountability (towards each other of the networking parties, beneficiary groups and larger community, donors, other stake holders), non-political, non-judgmental, non-coercive, confidentiality, and being inclusive (of all diversity). Lack of

  • Program implementation steps (planning)
  • Organizational policy, directives and strategies
  • Administrative & Financial policies
  • Program Standard Guidelines (Regulatory & Operational)
  • Responsibility & Accountability
  • Transparency
  • Social system audit
  • Organizational communication patterns
  • Trained human resources for specific jobs
  • Monitoring, evaluation and follow-ups
  • Regular staff meetings, orientation, briefings, etc.

Since we began our work in the central orphanage in the year 2005-2007 under Infant Care Facility Improvement Project”, we worked round the clock to prepare “leg-work” that were intangible but were essential to bring about positive changes. Building trustworthy relationship with the caregivers, care mothers, employees, management, executive board members and stakeholders and other supporters were the key areas we focused on. On this foundation, we introduced basic elements of childcare and education for the first time in the orphanage. We jointly worked with care mothers and junior staff to help facilitate interpersonal coordination and communication; conducted weekly care mothers training, orientation and coaching on improved health, hygiene and sanitation; developed infants friendly environment in the care-room setup; revamped internal physical infrastructures of infant care room by upgrading lighting and heating system, furnishing care room outlook, installing sanitizer dispenser and disinfections jell, providing safe drinking water system, provided individual crib for each infant to prevent diseases from spreading out to other babies, developed adequate areas/spaces for physical and mental stimulation of infants, improving age-old conventional child care system into effective, scientific, pragmatic and culturally appropriate intervention modalities.

We have observed remarkable improvements in term of raising knowledge, skills and understanding of care mothers about their roles and responsibilities, a environment of trust, cooperation, team building, practices of mutual sharing, respecting colleague works, working with common senses.  Besides, the physical improvement of infant care rooms which is obliviously visual is yet another indicator of positive evaluation of intervention program. Last but not least, the repeated demands for scaling up and spreading in other parts of the country also demonstrate how effective it was for them to reach to their goals. These ideas, approaches and strategies, which is a great achievements and has brought positive changes would be properly institutionalized and documented