Despite the existence of pre-primary education policies in 48% of low- and middle-income countries, significant disparities persist in learning, development and the school readiness. While Nepal’s has established policy commitments to early childhood development, significant gaps remain in delivering quality pre-primary education, particularly in rural areas and for marginalized communities including children with disabilities. Key challenges include inadequately trained teachers, limited inclusive education practices, insufficient parental engagement, and poor learning environments during the critical developmental period. These gaps result in children entering primary school unprepared, leading to poor learning outcomes, higher dropout rates, and widening educational inequalities that undermine long-term educational success.

Every Newborn Reach Up Early Education Intervention for All Children (EN-REACH) project was successfully implemented in five districts of Gandaki Province, including a cohort of children born at the Western Regional Hospital in Ramghat, Pokhara. Best practices and evidence from EN-REACH were then used to scale up the early childhood development (ECD) education intervention to 24 schools in the Nuwakot and Dhading districts. This research project is supported by GPE KIX for a period of 33 months. We have taken a triad approach to make teachers, parents and communities ready to prepare the young children (between 4 to 7 years of age) for the school. In close collaboration with national ECD experts, central, district and local level stakeholders, a customized inclusive teacher training manual will be developed in adherence to the national ECD curriculum. Simultaneously, the ENREACH parenting manual, endorsed by the Central Education Human Resources Development (CEHRD), will be adapted to make it more relevant and effective. Master trainers from districts and municipalities will be trained at the national training center and will then train ECD teachers. Thus, teachers will gain the skills needed to include children with disabilities and implement the ECD approach. The ECD teachers will also take the role of facilitators, conducting sessions with parents to prepare children for Grade 1 together. There will be structured, periodic supervision of classes by the trainers, including the parenting sessions.

This study is called EN-REACH (Every Newborn – Reach up Early Education intervention for All CHildren) and builds on a previous observational cohort study EN-SMILING, it will evaluate the impact and implementation of a pre-school parenting program aimed at improving school readiness in Bangladesh, Nepal & Tanzania with three objectives.

Helping Babies Breathe (HBB) training program roll out has been fundamental in making improvements in the uptake of neonatal resuscitation protocol in the low and middle-income settings. The training program has been successful in improving the performance both in simulated and clinical settings, on initiating the ventilation in non-breathing manikin and babies within first minutes of life. Thus, HBB program has been successful in bringing a global momentum on importance of ventilation in the Golden Minute^TM. Evidence from several studies in high income setting has shown that to ensure adequate and effective ventilation, maintaining the rate of ventilation at 30-50/minutes and adequate chest rise (adequate tidal volume) is important. Therefore, further improvement in the HBB training needs to be done in terms of building the competency on continuous ventilation of babies within first minute after birth at 40-60/minutes and ensuring adequacy of ventilation. There is a need to develop tools to provide reinforcement in the trainings of HBB for adequate and effective ventilation.

Laerdal Global Health and Laerdal Medical have developed a bundle of products in order to improve the quality of neonatal resuscitation health workers are able to provide There are three novel interventions that will be tested during the study period.

Accurate data are crucial to track progress towards the Global Strategy and the Ending Preventable Maternal Mortality (EPMM)/ENAP vision to end preventable maternal and newborn mortality as well as stillbirth. Impact data, including mortality and birthweight/gestational age and data regarding coverage of interventions to ensure we are reaching those in need, are integral to global governance, finance planning and local program planning. In this regard, the global ENAP technical advisory team together with London School of Hygiene and Tropical Medicine (LSHTM), Nepal Health Research Council (NHRC) and Golden Community is committed to EN-BIRTH study to validate the newborn indicators collected from the health facilities, evaluate the quality of care provided at health facility and validate whether the health facility based indicator can be collected from the periodic national and sub-national survey by 2018. The objective of the study is to evaluate the accuracy and precision of the data collection on women receiving uterotonics, women receiving antenatal corticosteroids, neonatal resuscitation, essential newborn, newborn receiving Kangaroo Mother Care (KMC) and newborn with infection. The study is being conducted at Pokhara Academy of Health Sciences.

The Monivent Neo Study is being carried out in public hospitals and will include 60 health workers (clinicians and nurses) who are actively involved in providing perinatal care services in the hospital. The health workers should be trained in Helping Babies Breathe (HBB) prior to the study. This is a simulation-based study and entails a measuring and monitoring equipment to be used in combination with existing manual ventilation devices (3kg NeoNatalie). The airflow is measured directly in the face mask using a sensor module integrated in the face mask. The sensor module uses a differential pressure sensor to measure the pressure drop over a membrane placed in the face masks upper tube to receive the airflow. Flow and pressure measurements are used to calculate number of ventilation parameters. Written Informed Consent is taken prior to the session.

The participants, in randomized order start ventilating with the monitor display hidden or visible when conducting the two ventilation sessions. An Objective Structured Clinical Examination (OSCE) is used to evaluate the ventilation skills of the participant (only during visible session). Participants are subjected to fill Confidence Rating Scale Form after both sessions.

The device will provide continuous and real-time feedback to the health workers on newborn resuscitation performance. This will improve the impact of ventilation to the babies in need of bag and mask. If successful, the device will be incorporated in the neonatal resuscitation trainings to hone the health worker’s ventilation skills and boost up their confidence in carrying out resuscitation on babies.