Sheetal is 8 months pregnant with her first child. She walked for four hours to a district hospital to get herself a zinc tablet and an analgesic drug that aren’t available anywhere closer. Kelsang Dolma Lama, a 24-year-old nurse working in the Humla District Hospital, is not surprised. Humla District Hospital serves about 30 girls and women in maternity every month. Sheetal’s story is similar to many others who come here frequently. “Sheetal is already in her third trimester and is severely deprived of proper food and nutrition as she hadn’t gained enough weight,” says Kelsang. Kelsang realized Sheetal didn’t know what proper nutritional food was. It was difficult to just get a proper meal, the nutrition that she and her child needed seemed like a mere talk that the healthcare person did. She wonders if the baby is developing well.
Kelsang Dolma Lama, social mobilizer
Kelsang has been working for over a year in the District Hospital in Humla. Humla is a place that is touched by the highway, yet many people there don’t have access to basic infrastructures such as transportation, electricity, clean water, and proper health care. The climate is harsh, with snow for up to four months of the year. There is practically no irrigation, the soil is poor, and the land is very dry and arid. The growing season is short, all of which contributes to low agricultural yields. On average, most households only produce sufficient food for 3-5 months of the year. Humla has a domestic airport which is the only way out from there and the airport can only give services to small aircraft and helicopters due to its short runway. With the topography being so difficult, the food available in the shops has to be chartered by helicopter or airplanes making the cost of the food remarkably high.
“People have to walk for hours and some even for a whole day to just visit the hospital”, says Kelsang. “These maternity patients are deprived not just of proper food and nutrition but also deprived of adequate rest.” Most of the people of Humla are farmers and they spend their entire day working on their fields, rearing cattle, and feeding them. Pregnant women like Sheetal wake up early in the morning, do their household chores, work in their field all day, and usually end up coming back home to empty plates.
There are numerous stories that are uncovered and unheard of, stories of pregnant women who starve to death, stories of maternal women who die due to lack of proper nutrition, proper healthcare, and health infrastructures. In 2020, the maternal mortality ratio for Nepal was 156 deaths per 100,000 live births. A report from 2020 suggests that there is a 200 percent increase in maternal mortality rate since the lockdown began in 2020 after the Covid-19 outbreak. A majority of these death cases are from the rural parts of Nepal like Humla.
Starting August 2021, team Rahat partnered with Rural Community Health Care Nepal (RCHC) to support women like Sheetal in Humla. RCHC, primarily run by midwifery officers, is a non-profit organization established with a mission to help marginalized and underprivileged populations and pregnant women with medical needs. “Because of lack of proper health care facilities and the rising number of covid infections in Nepal, most of the hospitals were swamped by Covid-patients making it difficult for pregnant women to deliver their babies safely in remote areas of Nepal. We started a 24-hour hotline service to support women in maternity. Through the hotline, we also provided instructions to midwives and conducted training sessions on “Childbirth Education for Young People”, said Ms. Prasansha Budha Lama, one of the founding members of RCHC. She further added, “Quite a few women we connect through the hotline are in dire conditions and need support. With team Rahat, we are looking at extending our support with essential medications, nutrition and transportation for women in maternity especially in a remote area like Humla.”
The pilot, “Nutrition tokens for Women in Maternity”, a collaboration of RCHC and team Rahat aims to provide maternity and child support to marginalized pregnant women, their newborns, and their families. The pilot distributes nutritional food items to pregnant women through the Rahat platform. The pilot undergoes a careful needs assessment by Rural Community Health Care (RCHC) and Kelsang with support from the local community leaders of Humla. The need assessment is done on the basis of their ability to afford the health care services and their family’s economic condition. Kelsang says, “The hospital has a shelter home for pregnant women who come from far away. Since most women live far from the hospital and can’t walk home after the delivery, they stay in the shelter home. Most women who stay in the shelter home can’t even afford to buy a bag of rice so I have been recommending their names for support through our needs assessment.”
Kelsang uses Rahat’s “social mobilizer app” to register vetted beneficiaries, and assigns them nutrition tokens and a QR code-based smart card. The beneficiaries take their smart card to a participating vendor to redeem their token for nutritional food and hygiene items.
A beneficiary receiving her aid by transferring the QR code to the vendor
For this pilot, a local female vendor, Pabita Tamang was onboarded to provide the nutritional relief items to assigned pregnant women. Tamang uses Rahat’s vendor wallet app to receive tokens from the beneficiaries and redeem them as needed. “I am so happy to be part of this pilot. Me being a mother myself, I understand the need and importance of nutrition in this situation. For me to be able to distribute the aid through my own store has not just helped the beneficiaries to receive aid easily but has also helped me financially and I have also realized new technologies are not too hard to adopt!”, says Tamang.
A beneficiary receiving the nutrition aid packages
Rahat manages and monitors the flow of transactions in cash and voucher assistance projects. With blockchain-based tokens, Rahat maintains end-to-end transparency among various stakeholders with real-time visibility into the flow of funds to the aid agency. “It is not that there has never been any aid distribution process before, but there was no proper track of who should receive the aid, who actually needed it, and also keep track of who received the aid. But with the Rahat platform, it was we who could access the needy ones, keep a track of what amount was deployed, who received the aid and it was all so instant and fast. I feel so proud that I am one of the actors who has helped these women in need to receive the aid that they needed”, says Kelsang with a smile of satisfaction on her face.
Aid agencies can use Rahat’s online dashboard to easily set up, deploy, and monitor relief projects. Since aid distribution can be monitored in real-time it cuts down admin and auditing costs associated with the projects. In this particular pilot, Kelsang used the social mobilizer app to register beneficiaries and assign them tokens. Since Sheetal did not have a phone, she received a QR code-based smart card that she was able to take to her local vendor to redeem for nutritional food items.
Kelsang says, “In previous relief distributions, some people would receive the aid twice or thrice while some would receive none. It is all because of the lack of a proper system”. She adds, “At times, the fund for distributing the aid is handed over to some group of people who provide low-quality products and there is nothing we can do about it as we cannot trace them.”
Rumee Singh, co-founder of Rahat says, “Rahat brings in accountability and transparency in the forefront of Cash and Voucher Assistance programs. With blockchain technology, we help humanitarian organizations monitor their aid distribution project in real-time and cut audit costs. Through this pilot, we’ve been able to test the technology in a challenging area like Humla.”
Local Vendor using the Vendor app
Rahat started with a mission to support vulnerable communities by enabling a transparent and trackable aid distribution platform built on blockchain technology. It has impacted over 3000 beneficiaries and local traders through its pilots in Nepal. With UNICEF Innovation Fund’s investment, Rahat has developed an open-source agency dashboard, a vendor wallet app and has recently introduced NFT tokens for support packages.
Rahat’s pilot with RCHC continues to support women in Humla. “There were many such promises that several organizations made during their visits to the hospital, but we never received aid in any form. We just heard the stories of how the aid was received by people who were already well to do and did not even require them, but we did not even know when and where was it distributed as we lived far off the market and have to walk for hours but this time, I am so happy that I received this package”, Sheetal said with tears in her eyes.