By: Bharat Ban, Ashoke Shrestha, Leela Khanal, Henry B. Perry, and Steve Hodgins
52,000 Female Community Health Volunteers serve as part of the Nepali community health workforce. These part-time volunteers primarily support health education, counseling, outreach, and resource distribution. Each volunteer receives counseling, supplies, and other resources from their respective health center on a monthly basis. Their cumulative efforts have contributed to Nepal’s global leadership in maternal and child health outcomes.
Background
Nepali health planners and program managers recognized the geographic and social challenges to providing health services in its population of 29 million people and introduced several cadres of community health workers and volunteers. These have included the full-time, paid Village Health Workers (VHWs) and Maternal Child Health Worker (MCHWs), and part-time voluntary Female Community Health Volunteers (FCHVs). Nepal also has two cadres of health auxiliaries, each with approximately 18 months of pre-service training: Auxiliary Nurse-Midwives (ANMs) and Auxiliary Health Workers (AHWs). This chapter focuses on FCHVs.
Implementation
Each of the most peripheral health facilities in Nepal serves a catchment population typically numbering 5,000–10,000 people. In the past, each had at least one professional health worker, one VHW, one MCHW, and at least nine FCHVs. Now there are no longer MCHW and VHW positions, as they have been replaced by ANMs and AHWs. Nepal has about 52,000 FCHVs. FCHVs are frontline, part-time voluntary service providers who serve as a link between the community and government health services.
Roles/responsibilities
Historically, FCHVs mainly had four functions: health education and counseling, support for outreach services, distribution of health commodities, and provision of sick-child care. However, their roles and responsibilities have evolved and changed over time, and more recently their role in sick-child care has declined. They are engaged in FCHV-related functions on average 7 hours a week.
Training
FCHVs receive 18 days of initial training as well as ongoing in-service training.
Supervision
It used to be the case that most supervision was done by VHWs and MCHWs during their regular outreach activities. However, most FCHVs now visit their respective health facility every month; there, they receive supplies, materials, commodities, and programmatic advice and feedback. This has largely replaced monthly contacts associated with outreach visits. Supervision is now done by AHWs.
Incentives and remuneration
FCHVs are volunteers but are provided training allowances, refresher trainings, an annual clothing allowance, access to microcredit funds, and other incentives. They receive a uniform, a bag and a startup kit of supplies. In addition, FCHVs also receive additional variable incentives from their local municipalities. Working as a FCHV is considered a privilege and although many FCVHs would prefer more generous financial incentives, almost all report being highly motivated to continue in their role even without significant changes in their conditions of service.
Impact
Among low-income countries, Nepal has been a global leader in reducing its under-5 mortality rate, pregnancy-related mortality ratio, and fertility rate (reflected in Nepal having succeeded in reaching Millennium Development Goals 4 and 5). There is widespread agreement that Community Health Workers (CHWs) in Nepal, particularly the FCHVs, have played an important role in achieving these important goals.
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