When Tulsi Bikal was pregnant, the nearest antenatal checkup was three hours away by car. Her local facility, Bhur Health Post in Bheri Municipality of Jajarkot, did not have the capacity she needed, so she travelled to Chaurjahari, in neighbouring Rukum West, on mountain roads that disasters regularly closed. Some months the journey happened. Some months it could not. And the health post she passed on her way out of the village had troubles of its own: last year it went without electricity for more than 1,000 hours, the equivalent of 41 days in the dark.

"Now I can receive antenatal checkups close to home, without worrying about long journeys," Tulsi says. Her sentence carries more weight than it seems. Nepal's progress on maternal health is one of the great developments of its generation: maternal deaths fell from 539 per 100,000 live births in 1996 to 151 in 2021 (Nepal Maternal Mortality Study, 2021). But the gain thins at the edges of the map, in the places where climate change presses hardest.

That is where a UNFPA project, supported by the Government of Japan, went to work after the 2023 Jajarkot earthquake and the 2024 Rautahat floods: strengthening climate-resilient maternal and newborn care in Rautahat, where floods and extreme heat recur, and in Jajarkot, where landslides and cold waves do.

The method was patient. Policy analysis and facility assessments located the gaps; local governments turned the findings into costed action plans; ten healthcare facilities across the two districts were refurbished; and Female Community Health Volunteers were trained to respond to climate-related health risks and emergencies.

At Bhur Health Post, a renewable energy backup keeps the lights and equipment on when the grid fails. Insulated ceilings and proper heating and cooling hold the delivery and care rooms steady through cold waves and heat alike. And a Doppler device lets a health worker find what every anxious mother is listening for: the small, insistent heartbeat of a child on the way.

Reflecting on the municipality's costed climate adaptation plan, Mayor Chandra Prakash Gharti said the local government would keep coordinating with health posts, Health Facility Operation and Management Committees, and provincial and federal partners to sustain the improvements. The plan, in other words, has owners, reflecting on the development of its costed climate adaptation action plan, said the local government would continue coordinating with health posts, Health Facility Operation and Management Committees, and provincial and federal partners to sustain these improvements.

UNFPA Nepal is now supporting the Government of Nepal in carrying the model to other districts and provinces, with Bhur as one working proof. The work ahead is unglamorous and essential: keeping power systems maintained, plans funded and volunteers trained, so that the next earthquake or flood interrupts nothing a mother needs.

For Tulsi, the change is simpler than any of that. Checkups happen close to home now, at a facility open around the clock, emergencies included. The road to Chaurjahari is still long. She no longer needs it.

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Ms. Tulsi visited Bhur Health Post for her postnatal checkup with her child.

 

Postnatal care room of Bhur Health Post before the refurbishment work.

 

Postnatal care room of Bhur Health Post after the refurbishment work.

 

Wind turbine at Bhagwati health post