Caring communities in Nepal: How EMMS International have supported thousands with compassionate palliative care

As EMMS International’s three-year UK Aid Match project in Nepal comes to a close, people with life-limiting illnesses and conditions are receiving the support they need, and long-held stigma around palliative care is starting to shift.

In Nepal, the concept of palliative care is still very new, and people are often unable to access the services they need to live comfortably and manage their illnesses or conditions, which can be extremely isolating. As well as this, children often take on extra household chores, as the work in the household expands when one family member needs the others to care for them.

With funds raised through their UK Aid Match appeal, EMMS International’s Sunita project is changing this, developing caring communities in partnership with healthcare professionals, teachers, and community groups.

The Sunita project offers a holistic approach to palliative care through cost-effective and sustainable health and social care services. Healthcare professionals and community workers have been trained to recognise the needs of those requiring palliative care, ensuring people can get the right support sooner and more effectively. This mix of community and healthcare training ensures people living in remote areas – who are unable to access a hospital – can still be supported within the community. For people who are able to travel for care, a dedicated wing at Green Pastures Hospital (GPH) in Pokhara is available where patients can receive specialised treatment and access vital pain relief and resources such as counselling.

Stories of change

When Ramesh was 17, he suffered a life-changing fall that left him very sick and feeling hopeless. His mother Lakshmi became his main carer. Through the Sunita project, Ramesh and Lakshmi now have a growing community of support around them. They receive home visits from community nurses and doctors so they are less isolated, and travel to GPH for specialised treatment and essential medicine.

Photograph: Ramesh at home

83-year-old Jit was born with no legs below his knees, affecting his ability to walk. His son Dal works as a builder and is proud to take care of his father, albeit he did this alone. Now, they are both supported by Ganga, a Female Community Health Volunteer who lives nearby in their community. After receiving training through the Sunita project, Ganga visits Jit around four times a week, and guides him on better sleeping positions so he is comfortable, supports his care needs, and provides crucial updates to his medical team in Sahodar so they can keep track of his progress.

Photograph: Ganga, Jit’s Female Community Health Volunteer

Advocacy, community support and caring societies

One of the most powerful aspects of the Sunita project has been its focus on the holistic, human side of healthcare. Dr Dan Munday, palliative care consultant at GPH and adviser to the Sunita project, explains how palliative care training goes beyond end-of-life support, shaping compassionate communication skills that can enhance other areas of health care too. “We are now gaining pretty good evidence that palliative care is a way of enabling people to develop those interpersonal skills, which then go across the whole practice. And they’re not just to do with end of life care or people with advanced illnesses but actually it’s something that strengthens your work with anybody.”

Empathy, compassion, and advocacy are central to this approach, supporting not only healthcare professionals, but volunteers and teachers. By centring local voices and investing in community volunteers, the project demonstrates that palliative care can be both accessible and deeply meaningful, even in remote regions. As palliative care becomes more recognised and accepted, teachers trained through the project are now able to provide child carers with additional support so they can continue with their studies.

 “So that’s what we need, to actually work on all the aspects…. not just the physical aspects of things, but the social, the spiritual aspects and psychological aspects. You need a person who’s empathetic to cater to the needs of the patient or their family.” Dr. Amrita Shrestha, paediatrician and palliative care physician at GPH.

Photograph: Outskirts of Pokhara in Nepal, where Ramesh (mentioned above) lives

The legacy of the Sunita project

The project’s strong emphasis on holistic approaches and breaking stigma around palliative care is key to building evidence to support the Government of Nepal’s national care strategy, laying the groundwork for future policy and government action.

Not only is immediate impact from the project clear to see, but a rise in female leadership in palliative care in Nepal is also providing hope for a long-lasting future.

Take Dr. Amrita for example (quoted above). Encouraged by the success of the Sunita project, she has pursued specialised training and completed a fellowship in palliative care. On top of being a skilled clinician she has become a passionate advocate for children’s palliative care, an area that is critically underserved in Nepal.

And it is not just health care professionals. Arati has always been drawn to research and found herself leading a team of researchers under the Sunita project. Their work has contributed to multiple palliative care studies, with findings shared at national and international conferences, giving vital voices to patients and caregivers through data and evidence.

Dr. Bishnu Dutta Paudel Bucha, Professor of Medical Oncology and President of the Nepalese Association of Palliative Care is certain that the work of the Sunita project is shaping the way for palliative care across the whole of Nepal. “This finding of the Sunita project is very, very helpful if we really can use it to amplify in other districts of Nepal”.

These initiatives show that the Sunita project has not only paved the way for creating sustainable change, but with continued momentum palliative care in Nepal and beyond can be given the attention it deserves.  

Read more about EMMS International and the Sunita project.

And follow them on social media to learn more from health care professionals involved in the project.

In May, the UK Aid Match team travelled to Nepal to visit grant holders and their delivery partners – EMMS International, PHASE Worldwide, Practical Action, United World Schools and WaterAid.

The visits were an opportunity to deepen our understanding of project progress and challenges and to offer support, for example, with safeguarding, reporting expectations, and financial management.

Below is a brief summary of the visits:

EMMS International are supporting people with holistic palliative care through cost-effective and sustainable health and social care services, and empowering family members and groups to provide support, improved healthcare and engender more caring societies.

Our team visited the Palliative Care Centre of Excellence based at the Green Pastures Hospital (GPH) in Pokhara. Here they observed remote mentoring sessions for the Palliative Care Doctors and Community Educators, through the ECHO tele-mentoring system (Extension for Community Healthcare Outcomes), a crucial forum for shared learning, identification of new palliative care patients and improving quality of patient care.

Visiting one of the rural health posts, our team met Female Community Health Volunteers (FCHV) who highlighted the growing awareness and value placed on palliative care as a holistic approach, which is a significant achievement in a country where the concept of palliative care is still very new.

Photograph: EMMS International, their delivery team and UK Aid Match team members Emma and Bridget outside one of the hospitals

PHASE Worldwide are improving maternal health and reducing malnutrition for 1,000 women and their children in Bajura, Far West of Nepal. This is a difficult location to access, requiring a seven-hour drive on rough terrain, followed by a seven-hour hike, which the Phase team undertake often as part of their work. The region is also prone to natural disasters such as earthquakes and landslides, and these can severely impact delivery of healthcare services.

Despite the contextual challenges and remoteness of the project PHASE is meeting and surpassing many of its project goals, and it was great to discuss this with them. The team has delivered safe motherhood training to 891 women and is seeing increasing rates of exclusive breastfeeding as a result (amongst other changes). The project also supports a range of agricultural skills training to help increase food production and dietary diversification for pregnant women and new mothers.

Photograph: A mother feeding her child a nutritious meal

Practical Action are working with women and marginalised groups in three rural districts in Nepal to build climate adaptive farming opportunities and improve livelihoods. 

Having visited some of the project sites previously (in 2022), our team utilised this second visit to meet Practical Action project staff in their offices in Kathmandu. The project team shared updates and explored ways to further communicate the positive impacts of the project as it moves into its final stages.  

The project has improved water access through innovative solar-powered irrigation systems, and has helped establish climate field schools which provide farmers with training on commercial vegetable farming, agroecology and regenerative agricultural practices. Some of the climate schools have introduced labour-saving devices such as electric corn shellers and farm rakes, helping women feel more empowered as they save valuable time and labour.

The project also has strong connections with district and regional private sector actors and traders which is a significant strength of the design. These linkages will be crucial for ensuring sustainability as the project comes to an end.

Practical Action are sharing more about this project at the COP29 talks in November, using it as a working example of how to achieve systematic change at scale.

United World Schools (UWS) are supporting children to enrol and stay in school in remote regions of Nepal, while developing education facilities, school management structures and supporting teacher employment and training.

During the visit it was clear that the positive collaboration between local government stakeholders (education offices) and the UWS team is a key strength of the project and the broader work of UWS, helping facilitate innovative educational initiatives.

The school communities appeared vibrant and supportive, with strong engagement from mothers, School Management Committees (SMCs), and Student Representative Councils (SRCs). These groups play a pivotal role in fostering a positive learning environment and nurturing the holistic development of students. The investment in infrastructure was also evident, with well-maintained school buildings, well-equipped classrooms, and productive teacher spaces, all contributing to an enriching educational experience.

Photograph: Members of our team visiting UWS Koksha School, Tumlingtar

WaterAid is enhancing the quality of learning environments for adolescent girls and children with disabilities in targeted schools of Bardiya. They are collaborating with schools, the broader community and authorities to improve access to sustainable, inclusive WASH services and menstrual health.

While the project experienced some delays in its first year, it was encouraging to learn about the progress being made and the positive direction of activities. The team highlighted that good coordination is developing with key stakeholders, such as The Ministry of Education. Menstrual health awareness training for teachers and local government staff has also started.

In the coming period, the project plans to install a new school water system, including a deep borehole, a water pump with bio sand filters, and dedicated handwashing and drinking stations.

Photograph: Sandhya, a participant in the project

A thank you

We would like to take this opportunity to thank all the organisations and individuals involved with these visits. We really appreciated all your time and continued hard work.