MoU between 'SAF' and the South Asia Madanjeet Institute of Assistant Nurse Midwife

Conference Nepal - 26th March 2007

Memorandum of Understanding between the South Asia Foundation and the South Asia Madanjeet Institute of Assistant Nurse Midwife, Jiri Technical School, Council of Technical Education and Vocational Training, Nepal, Poverty Alleviation Fund and Dhulikhel Hospital.


This Memorandum of Understanding (MoU) dated March 26th 2007 between the South Asia Foundation (SAF) and the South Asia Madanjeet Institute of Training Assistant Nurse Midwife (the Institute), Jiri Technical School, CTEVT, Poverty Alleviation Fund (PAF) and the Dhulikhel Hospital-Nepal sets forth the agreements reached between the parties relating to establishment and implementation of the Institute. This MOU is drawn up further to the approval by the SAF Governing Council Meeting of 27th November, 2006, Delhi, of a proposal submitted by Dr. Rita Thapa, SAF Chairperson-Nepal.

Establishment, Organisational Structure and Management

The Institute will be established as a non-profit, functional entity under the overall umbrella of Jiri Technical School, CTEVT. This is to ensure accreditation and conferral of certificates as well as for cooperation on other related matters. It is understood that CTEVT will be willing to enter into such an agreement with the Institute, subject to appropriate institutional and financial arrangements.

Although the Institute will be associated with Jiri Technical School, CTEVT, the organizational and management structure of the Institute will be steered by a governing committee. Such arrangement would allow academic autonomy to encourage creativity and maximum contribution of its partners including faculty, fellows, trainers and students in fulfilling the core objectives of the Institute and that of the concerned partners.

To start with, the existing faculty of the Jiri Technical School will be strengthened and supported by the resource persons from Dhulikhel hospital and Perinatal Society of Nepal for which appropriate remuneration will be made available by the Institute. Commensurate with the objective of regional exchange and collaboration, both the permanent and the part-time faculty of the Institute will be drawn from SAARC countries, where appropriate.

Why Establish the Institute: Rationale

Contributing to SAF overriding goal

The institute will feed into the cardinal SAF objective of promoting regional cooperation and peace through education and mutual understanding among the young people of South Asia. As the leading regional institution of its kind, it will undertake teaching and imparting skills on the subject and also invite students from other South Asian countries in coordination with the various chapters of the SAF.

Saving the lives of women and their babies

The technical basis of this proposal comes from the fact that a larg majority of women in South-East Asia risk death while giving life. The Maternal mortality ratio in South-East Asia is among the highest in the world, that includes Nepal.

Evidence shows that skilled health worker during childbirth can save lives of mother and her newborn baby. The World Health Report of 2005 has highlightened the evidence that higher the unattended births by skilled birth attendant (Community Midwife), higher are the maternal and neonatal deaths. In that, South-East Asia tops the list-it is almost at par with the Africa region. Implicit in such high maternal mortality is the silent death of huge number newborns, mainly due to maternal health problems and lack of skilled care at birth. Of the total annual infant deaths in Nepal, over 66 % occur among babies within the first 28 days after their birth. A similar situation prevails in all South Asian countries as well.

Improving Density of Skilled Birth Attendant & Attaining the MDG

The density of skilled health workers per 1000 population in South-East Asia is only 4.3 compared to 18.9 in Europe (WHO Report 2006). The 2006 Nepal Demographic and Health Survey showed that the proportion of births attended by skilled health workers in Nepal is only 19%, which is far behind the government and Millennium Development Goal (MDG) of 60% by 2015. A similar situation exists in rural and remote areas of other South Asian countries. Skilled birth attendant/ Community Midwife SBA/CMW is the cutting edge for reduction of maternal and neonatal mortality.

SBA/CMW connotes an accredited health professional such as midwife, nurse, health assistant and doctor who is proficient in skills required for managing normal pregnancy, child birth, the immediate post natal period and identification, management and referral of complications in mother and her baby.


The Institute will establish itself as a centre of excellence for training as well as research and education on SBA/CMW for qualified young women from the remote and disadvantaged communities from within and outside Nepal.

Specifically, the Institute aims to:

  • Increase the opportunities of Madanjeet Singh ANM scholarships among the poorest and disadvantaged groups of women.
  • Improve ANM density in the poorest communities.
  • Improve ANM attended births in the poorest communities.
  • To expand & mobilize partnerships.


A set of strategies are proposed as key to attaining the above objectives. They are as follows.

1. Building on what has worked

Since Jiri Technical School, had successfully implemented the training of the first batch of Madanjeet Singh ANM scholarships, it will be main locus of the Institute.
The implementation of the Institute and this MoU will be guided by a few take home messages that emerged during the planning and implementation of the pilot 50 Madanjeet Singh ANM scholarships in assistance of PAF benefiting the qualified women from the six poorest districts of Nepal where PAF is working. These lessons are that:

  • Assistant Nurse Midwife (ANM) scholarships can be reached to the poorest communities.
  • 80% of qualified women for ANM can be found among the disadvantaged groups – Dalit and Janajati.
  • Community participation guarantees success and sustainability.
  • A win-win partnerships works.
  • SAF goal of inclusiveness can be realized.

2. Project Coordinating Committee

The governance of the Institute will be done through a « win-win » Partnerships: A governing body consisting of members from the partnering organizations, SAF Nepal, PAF, CTEVT, Jiri Technical School, Dhulikhel and Thapathali Maternity Hospitals, and Chief of National Health Training Center, MOH will be formed under the chair of CTEVT. This body will steer the entire planning, implementation and monitoring of the said project as outlined in this MoU. This committee will allow academic autonomy to encourage creativity and maximum contribution of its partners including faculty trainers and students in fulfilling the core objectives of the Institute and concerned partners.

The committee will be as follows:

1. Vice Chairman of the CTEVT   Chairman
2. Chairperson of the South Asia Foundation   Vice Chairman
3. Member Secretary of the CTEVT   Member
4. Representative of Poverty Alleviation Fund   Member
5. Representative of Dhulikhel Hospital   Member
7. Chief of National Health Training Centre   Member
8. Principal of Jiri Technical School   Member-Secretary

Terms of Reference of the Committee

  • The committee will meet at least once a year.
  • Review the implementation of the project
  • Make any adjustment necessary to strengthening of the Jiri Technical School and Jiri Hospital including the nearby health posts and sub-health posts with special focus to ANM training.
  • Review the existing operational & technical policies made by the Jiri Technical School Management Committee in the line with the SBA skills for ANM.
  • Review and Approve annual plan of action and budget forwarded by Jiri Technical School Management Committee.
  • The PCC will formulate its working procedures as necessary according to the prevailing rules and regulations.

3. Updating the Curriculum and Syllabus

The existing ANM curriculum and syllabus of ANM under the CTEVT will be reviewed and updated according to the government's policy on SBA. The Institute will prepare / procure necessary training materials as required, train the faculties and conduct training accordingly.

4. Selection Criteria: Affirmative for Dalit & Janajati

The criteria used in the implantation of the first lot of 50 MS ANM scholarships had succeeded to bring 80% women from the disadvantaged groups (Dalit and Janajati). These criteria included academic, social, geographical and poverty factors. In addition, affirmative points were accorded to qualified candidates from Dalit and Janajati groups. These very criteria will be used in selecting further candidates from the poorest districts with preference on PAF working districts and VDCs.

5. The Institute will accredit the Madanjeet Singh ANM scholarship-training program with the CTEVT

The Partner Organizations Of The Institute: Role & Responsibilities

South Asia Foundation

South Asla Foundation (SAF) is a voluntary, secular and no-profit and non-political youth movement founded by UNESCO Goodwill Ambassador Madanjeet Singh. Its cardinal objective is to promote regional cooperation and peace through education, mutual understanding and creative friendship among the youth of South Asia.

In keeping with its objective of promoting regional cooperation through education, South Asia Foundation has instituted a large number of scholarships for talented young students across South Asia. Realizing the presence of a vast, untapped pool of talent in South Asia and the growing but unmet need for quality training and education in the region, SAF is offering group scholarships or gender-paired scholarships to two students each from eight South Asian countries.

The SAF-Madanjeet Singh group scholarships will give students across South Asia an opportunity to train in a center ot excellence in the region. This endeavor is directed at ensuring that in the matter of higher education students from non-privileged backgrounds are dictated by choice and not by economic and social necessity.

Role and Responsibilities

SAF undertakes to contribute US $ 100,000/- (one hundred thousand United States dollars) annually towards the establishment and operation of the Institute (the contribution) over a period of 5 years. It will be paid by SAF to the concerned institutions as per the cost of the services.


Jiri Technical School, CTEVT

Established in 1982, as a joint project between the government of Nepal and the government of Switzerland, Jiri Technical School is a rural technical school run under the CTEVT. The main objectives of the JTS is to improve the living conditions of the rural communities by imparting the appropriate and qualitative skill in health, construction and agriculture trade for immediate application and self-employment.

This Institute is part of the on-going program of the initial 50 Madanjeet Singh ANM scholarships. The Institute will be responsible for strengthening the existing training and clinical facilities within the Jiri Technical School. These activities will be coordinated by South Asia Madanjeet Institute of ANM which will be under the umbrella of the Jiri Technical School.

The physical facilities, library and ICT, Jiri teaching hospitals and nearby health and sub-health posts, personnel will be made available to the Institute by the Jiri Technical School, CTEVT. In addition the Dhulikhel hospital will also provide as much as possible their satellite clinies for the training of ANM in maternal and neo-natal care.

Role and Responsibilities

  • To recruit candidates from the poorest districts of Nepal currently Pyuthan, Mugu, Darchula, Kapilwastu, Siraha, Ramechap including Dolakha (where the Jiri Technical School is located) according to the agreed criteria as mentioned above.
  • To liase with PAF portfolio managers including the PAF local networks existing in these districts.
  • To provide 18 months assistant nurse mid-wifery (ANM) training to 40-50 eligible applicants from the said districts in accordance to the SBA syllabus.
  • To work in good relationship with local community and relevant accrediting and regulatory agencies and partners so as to ensure full enrolment and full employment of its graduates, both within government and the private sector.
  • To establish and maintain an open and transparent system of training program during training and recruitment so as to enhance equal opportunity to qualified candidates and uphold the reputation of the school.

Poverty Alleviation of Nepal (PAF)

PAF is an initiative to support the third pillar i.e. targeted programme of the Tenth Plan/PRSP. The target beneficiaries of PAF are marginalized communities-the poor women, Dalit, Janjatis and vulnerable groups living below the poverty line. It provides resources directly to the poor, and thereby expects to bring efficiency and transparency of the work, and ensure community ownership over the development activities. PAF is guided by the principle that the poor themselves are the best source of information and the best to manage their own needs and resources.

The purpose and an overriding mission of PAF is to reduce extreme forms of poverty from programme districts. PAF aims to enable poor women, Dalit, Janjati and vulnerable groups to gain access to resources for their productive self-employment, to encourage them to undertake income-generating activities for poverty alleviation. PAF also emphasizes on social development to improve the quality of life. PAF seeks to address spatial exclusion through its focus on most deprived districts and reaching out to other poverty stricken areas through innovative programmes. PAF has also adopted a demand-led community based approach to poverty alleviation.

The Poverty Alleviation Fund Act 2006 has recognized PAF as an autonomous organization with inalienable authority. PAF Board is chaired by the Prime Minister that reflects the conviction, support and commitment of the highest echelon of Government of Nepal to the programmes and objectives of the Fund.

Role and Responsibility

PAF will help CTEVT to select ANM trainees from the six PAF pilot districts (i. e. Darchula, Mugu, Pyuthan, Kapilvastu, Ramechap and Siraha) and other PAF working districts based on set criterion agreed upon. PAF is to mobilize its networks including Portfolio Managers, Partner Organizers and Community Organizations to select appropriate marginalized women who are poor and socially excluded due to reason of caste, ethnicity and gender. PAF could support required fund particularly for advertisement, selection of students, regular monitoring and supervision and job counselling regarding the same.

PAF will help to link services of ANM trained under this MoU to the PAF supported Communities linking with Community Organizations (COs), encourage for self-employment with seed capital on their acquired  ANM skills in order to render services to the communities in their respective villages.

Dhulikhel Hospital

Dhulikhel hospital is an independent, community owned hospital which provides cost effective compassionate and quality health care services. The hospital is guided by the notion of social equity, sustainable development and harmony with nature. Dhulikhel hospital established as a community  hospital has always realized importance of community development in offering health care Community development has been accepted as the integral component in health care delivery endeavour. The health care services need to go together with development of human resource for health as well. Realizing this fact, Dhulikhel hospital has joined in hand with Kathmandu University to produce different categories of manpower.

Role and Responsabilities

Dhulikhel Hospital is willing to provide technical support to strengthen the existing health facilities,  Jiri Hospital and nearby health posts/ sub-health posts which are being used by Jiri Technical School for training purposes.

In addition, Dhulikhel Hospital will provide as much as possible its community based satellite clinics to be used as the training sites for ANM training. Dhulikhel hospital is willing to provide necessary training to the faculty of the Jiri Technical School with special reference to government approved SBA syllabus. Dhulikhel hospital will be supported financially for the said technical services.

Dhulikhel Hospital/ Dhulikhel Medical Institute will expand its infrastructure facilities, librairy and ICT, human resource development to enhance the further purpose of the aforementioned agreements and arrangements. The Institute will endeavour to establish partnerships with other reputed institutions for special inputs in the form of faculty and curriculum content.

Preparatory Phase Of The Institute: Activities and Outputs

The implementation of the MoU will begin in two parallel tracks. First track would proceed to implement the second lot of 50 Madanjeet Singh ANM scholarships already received. The second track would include a few preparatory activities, which are prerequisite to implement the MoU as well as to improve the quality of the on-going ANM training under the MS scholarships. The main preparatory phase activities include
  • Updating ANM curriculum & syllabus as approved by Nepal Nursing Council.
  • Preparing and procuring training materials as required.
  • Selecting and training 5 master trainers in core midwifery competency.

The expected outputs of this phase will include the ANM curriculum and syllabus updated, appropriate training materials prepared/availed and 5 master trainers are trained in core midwifery competency teaching skills. The preparatory phase would consist of 5 months.

Preparatory Phase Budget

An estimate for carrying out the activities during the readiness phase for 5 months is as follows.

Curriculum & syllabus review & updates   NR. 80 000
Preparing & procuring training materials   NR. 300 000
Training 5 Master Trainers   NR. 500 000
Total budget   NR. 880 000
US $ 12 054

The Institute will endeavour to establish partnership with reputed training institutions for specific inputs in the form of faculty and curriculum content. Which institutions are to be approached for partnership and the nature of association with them will be decided in due course by the governing committee of the Institute. The careful selection of prestigious partners who have high quality competence, programmes or facilities in the areas of ANM training will be an important aspect of the Institute's development.

Additional financial support

The Institute will be responsible for raising additional funds that may be necessary for the establishment and operation of the Institute. The Institute undertakes to inform SAF from time to time of additional support that may be forthcoming for the Institute.

Dated 26th March 2007.


H.E. Ambassador Madanjeet Singh
Founding Chairman of South Asia Foundation

Dr. Rita Thapa
Chairperson of SAF Nepal Chapter

Dr. Ram K.M. Shrestha
Medical Director, Dhulikhel Hospital

Dr. Ram Prakash Yadav
VC, Poverty Alleviation Fund (PAF)

Mr. Shiva Hari Dhakal
Principal of Jiri Technical School, Jiri