In recent decades, Nepal has made impressive strides in the healthcare field, in large part because to the Female Community Health Volunteers (FCHVs) initiative. These women have been instrumental in revamping Nepal’s healthcare system and are often the first to address health issues in their local communities.
In order to improve mother and child health outcomes, the program was first introduced in 1988. Since then, it has expanded to include a wider variety of healthcare services, such as family planning, vaccination, and disease prevention.FCHVs are chosen for their ability to communicate, willingness to serve, and dedication to their community. More than 51,000 FCHVs are already working across Nepal, and their efforts have significantly improved the healthcare system and provided a useful example for other nations to follow.
the FCHV program’s effects
Through promoting and facilitating the use of vitamin A, the FCHV program in Nepal has greatly improved maternal and child health outcomes. FCHVs have also contributed to improvements in a number of multidimensional poverty indices, including infant mortality, nutrition, and sanitation. By boosting health and wellbeing in Nepal, Sustainable Development Goal 3 is being attained thanks to these initiatives.FCHVs have been essential in increasing access to healthcare services in rural regions, busting health information misconceptions, and encouraging healthy habits. The program’s efforts have produced positive outcomes in a number of important areas, including family planning, nutrition, vaccination, hygiene, and the prevention and control of communicable illnesses. (I) Health of the mother and child
With an emphasis on ensuring that pregnant women get prenatal, safe birth, and postpartum care, FCHVs play a crucial role in delivering maternity and child healthcare services in Nepal. The initiative gives priority to healthcare treatments that are preventative and educational, which has helped to lower rates of maternal and newborn mortality. Between the 1996 NFHS and the 2022 NDHS surveys, the under-5 mortality rate dropped from 118 to 33 deaths per 1,000 live births, infant mortality dropped from 78 to 28 deaths per 1,000 live births, and neonatal mortality dropped from 50 to 21 deaths per 1,000 live births, according to the Nepal Demographic and Health Survey 2022.
According to a research that was published in the journal of the Nepal Medical Association, the FCHV program has resulted in a 50% decrease in maternal death and a 49% decrease in child mortality rates. In addition to increasing the use of zinc and oral rehydration solution (ORS) to treat pediatric diarrhea, which led to a drop in diarrhea cases, the FCHVs have played a critical role in enhancing access to and use of key healthcare services in rural regions. By making frequent home visits to expecting women and new parents to give essential health services, such as tetanus toxoid vaccines, iron, and folic acid supplements, they have also promoted institutional births and raised the level of prenatal and postnatal care.In addition to these initiatives, FCHVs have been critical in encouraging healthy habits and boosting awareness among locals. They have made a huge contribution to promoting healthy habits and giving their communities trustworthy health information.
During her 16 years of practice, RadhaThapa, an FCHV from Sunwal-5, Nawalparasi, saw considerable changes in the attitudes of the locals about health care. She said that individuals now often attend hospitals for checkups and timely deliveries because they are more aware of and attentive of their health. The FCHVs have been instrumental in helping the government of Nepal reach its goal for SDG 3.1.2, which is to have 73% of births supported by competent providers by 2022 and 90% by 2030 (National Planning Commission 2020). From 84% in 2006 to 93% in 2022, the proportion of mothers whose most recent live delivery was protected against neonatal tetanus. From 10% in 1996 to 80% in 2022, the proportion of live births supported by experienced providers has dramatically grown.
Family planning (II)
The FCHV effort has been successful in increasing contraceptive use in Nepal, which has assisted women in spacing out their pregnancies and decreased the rates of maternal and newborn death. Condoms, oral contraceptives, and intrauterine devices (IUDs) are just a few of the family planning strategies that FCHVs have been promoting and teaching women about. Additionally, they direct women to healthcare facilities that provide family planning services. FCHVs have been essential in raising family planning services’ visibility and accessibility in Nepal and empowering women to make choices about their reproductive health.
An FCHV in Sunwal-7, Municipality, Nawalparasi named Menuka Timilsina takes delight in helping her community by promoting the use of contraceptives, which has not only increased awareness but also decreased rates of maternal and infant mortality. “I feel happy,” she said, “to be known and respected as a doctor in my community.” In Nepal, FCHVs are very crucial for providing infertility treatments. They have received training to provide important information about fertility, infertility, safe abortion methods, and reproductive rights.
FCHVs were crucial in helping infertile couples by giving them accurate information on the many reasons of infertility, potential treatments, and resources for further help. When seeking for counseling services that are conveniently positioned close to public health clinics, they have come to be recognized as the first-hand trustworthy health person. One in six individuals globally, according to a recent WHO paper published in 2023, require access to high-quality, reasonably priced reproductive treatment.
FCHVs may aid in breaking down the stigma barrier around infertility in the community by giving truthful information. Additionally, they may act as a link between local communities and hospitals, ensuring that couples have access to quality medical care. For the purpose of eradicating stigma, preventing social embarrassment, and reestablishing social norms, FCHVs also play a bigger role in community action, education, and support groups. They are organized to close the gender gap and minimize the stigma associated with infertility.
The usage of any family planning technique among presently married women increased from 29% in 1996 to 57% in 2022, according to the Nepal Demographic and Health Survey (2022). Modern methods of contraception were used more often during the same time period, rising from 26% in 1996 to 44% in 2006 and remaining constant at 43% from 2011 to 2022.
Nutrition (III)
The FCHV project has significantly improved Nepal’s nutritional habits. Women’s knowledge of the value of breastfeeding, wholesome nutrition, and secure hygiene practices for their kids has greatly benefited from the work of FCHVs. They serve as the main sources of support and advice for women in their communities throughout pregnancy and the first few years of a child’s life.
Figure 6 shows that the prevalence of stunting has dramatically decreased from 57% in 1996 to 25% in 2022 according to the Nepal Demographic and Health Survey (2022). While the incidence of overweight has stayed constant at 1% during the same time period, the prevalence of wasting has dropped from 15% to 8%.
Hygiene (IV)
The FCHV project has significantly improved Nepal’s nutritional habits. Women’s knowledge of the value of breastfeeding, wholesome nutrition, and secure hygiene practices for their kids has greatly benefited from the work of FCHVs. They serve as the main sources of support and advice for women in their communities throughout pregnancy and the first few years of a child’s life.
Figure 6 shows that the prevalence of stunting has dramatically decreased from 57% in 1996 to 25% in 2022 according to the Nepal Demographic and Health Survey (2022). While the incidence of overweight has stayed constant at 1% during the same time period, the prevalence of wasting has dropped from 15% to 8%.
Immunization (V)
By organizing communities and ensuring that children get their immunizations on time, FCHVs play a critical role in immunization programs. They strive to dispel myths and concerns about vaccinations while raising awareness of the value of immunization. According to the Nepal Demographic and Health Survey (2022), the proportion of kids aged 12-23 months who have received all the essential antigens in a vaccination series has changed over time. According to Figure 5, it surged from 43% in 1996 to a high of 87% in 2011, dropped to 78% in 2016, and then marginally increased to 80% in 2022. The proportion of kids aged 12-23 months who did not get any immunizations, however, has also changed, somewhat rising from 1% in 2016 to 4% in 2022.
Managing and preventing communicable illnesses
In Nepal, FCHVs have been essential in controlling and preventing communicable illnesses. Infectious disease outbreaks like those caused by common children illnesses, diarrhea, pneumonia, TB, malaria, and dengue fever are something they are taught to recognize, control, and report. Additionally, they provide basic assistance and support to people impacted as well as educating their communities on how to stop the spread of these illnesses.
FCHVs have been crucial in spreading knowledge about the COVID-19 pandemic, the virus, and the value of immunization, mask use, and social isolation. They have been crucial in helping to track down contacts, keep an eye on the quarantine, and provide basic aid and support to individuals who are afflicted.
FCHVs are essential in their communities’ efforts to promote sanitation and hygiene. They spread awareness in their communities about the value of drinking clean water, handwashing, and appropriate waste disposal. The spread of infectious illnesses in Nepal has been significantly slowed down because to this education. Pema Lama, an FCHV from Tanahun, claims that during the COVID-19 epidemic, she helped identify homes with members who had immigrated from other countries and educated them about preventative measures. She advised them to follow her advice to remain in quarantine and take additional safety measures in order to prevent the COVID-19 pandemic from spreading further.Conclusion
FCHVs play a significant role in healthcare and serve as social change agents in their neighborhoods. They support gender equality, fight against violence against women, and support disadvantaged populations including low-income families and individuals with disabilities. Their efforts have aided in removing obstacles and altering attitudes regarding social and health concerns. Goma Niraula, the director of the Nursing and Social Security Division within the Ministry of Health and Population, underlines the value of FCHVs in advancing the healthcare industry and raising important health indicators. She advises that the Nepali government provide them various training programs depending on the changes brought on by the introduction of new illnesses.
FCHVs have had a substantial impact on their communities’ efforts to promote social change, prevent and manage communicable illnesses, and improve mother and child health. In addition to bridging the knowledge and healthcare access gaps between local people and healthcare experts, they are well-respected members of their communities. As the foundation of Nepal’s healthcare system, FCHVs should be honored for their contributions and encouraged to continue their work. The director of Suhara Health Program, Minraj Gyawali, applauds the FCHV program for making Nepal’s healthcare system functional and efficient. Suhara Health Program has been striving to strengthen the country’s health sector. By effectively using the FCHV program, Nepal has been regarded as a model for other nations looking to better their healthcare systems, he continues.