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Panchthar is a hill district of the Mechi Zone in Nepal’s Eastern Development Region. The district covers 479 sq mi and has a population of 195,460 with 5,300 pregnancies per year. The road network is extremely poor. Most of the existing roads are dirt that frequently wash out during the monsoon season, making travel extremely challenging. Most women have no pregnancy-related contact with modern health services and maternity services are under-utilized and low in quality. This was our 12th birthing center refurbishment with One Heart Worldwide.