Dr Naresh Pratap K CDr Naresh Pratap K CDepartment of Health ServicesDepartment of Health ServicesMoHPMoHP

Community Health Workers Meeting

MilestoneMilestone

◦Formulated to improve RH services where family planning, safe motherhood, child health and communicable diseases were identified as priority programs.

◦Restructuring of the Health System, ◦At least one health facility for one VDC◦Bringing health services closer to the

community◦Integration of vertical programs

(preventive, promotional and curative)◦Introduction of new Cadre: Maternal

and child health workers, maternal health being the priority program.

National Health Policy (1991)National Health Policy (1991)

Recognizing the importance of women’s participation in health promotion, GoN Initiated FCHV program in 1988/89

Pillars to Nepal’s Public Health ProgramsNumerous external developmental

partners and NGOs share their implementation level expertise and on going support to the program

Female Community Health Female Community Health Volunteer (FCHV)ProgramVolunteer (FCHV)Program

Community Health Workers in Community Health Workers in NepalNepal

Community Health Community Health WorkersWorkersMCHWs (3134) and VHWs (4015)

are employed by Government.Total of 48,549 FCHVs are

currently present in Nepal. One FCHV per ward or one per 500 population

Role of Maternal and Child Health Role of Maternal and Child Health WorkersWorkersConduct DeliveryConduct PNCCare of NewbornSupply FP commoditiesBCCManagement of diarrhoea and

pneumonia in the community under CB-IMCI

Supervision of FCHVsReferral Services

Role of Village Health Role of Village Health WorkersWorkersImmunization servicesManagement of Newborn

InfectionsSupervision of FCHVs

75 districts in Nepal

District is divided

into VDCs

12

35

7

4

96

8

Each VDC has nine wards & 1 health

facility Mothers group

FCHV

Settlement

Each ward has:•80-100 households•1 Female Community Health Volunteer (FCHV) who provides maternal and child care services in the community. •A mother group coordinated by FCHV for community mobilization

Settlement

Settlement

Community Health System

Female Community Health VolunteersFemale Community Health Volunteers

FCHVs are involved in:

Maternal and Neonatal Health

i) Family Planning programs

ii) PP Vitamin A and iron tablet distribution

iii) Awareness on maternal and neonatal health

iv) Provide essential neonatal care during birth and postnatal

Child health

i) Vitamin A distribution & de-worming

ii) Community based management of pneumonia & diarrhea

iii) Awareness on Immunization programs

Role of Female Community Health Role of Female Community Health WorkersWorkersDemand generation in the community for MNCH

servicesCounseling to Pregnant women and family on

birth PreparednessCommunity based management of pneumonia &

diarrheaManagement of newborn infections, birth a in the

community under CB-NCP program Behavior Change CommunicationDistribution of FP commodities (condom and

pills)During NIDs- Administration of Polio dropsReferral services

Achievements through community Achievements through community based interventionsbased interventionsNDHS 2001, 2006 and 2011 have

revealed significant improvement in Child Health indicators.

Source: NDHS

Improving Maternal & Child Improving Maternal & Child Health in NepalHealth in Nepal

Dramatic declines in child mortality

Improvements in maternal health◦ TFR dropped to 2.6◦ MMR from 539 to 281

(DHS 1996,2006) Most women in Nepal

still deliver at home (64%) and without a skilled provider (65%)

13

• NMR remains unchanged: Estimated 32,000 newborn deaths/year during their first month—most in first week

Achievements through community Achievements through community based interventionsbased interventionsFCHVs are extensively counseling and

raising awareness in the community for institutional delivery through Birth Preparedness Package

Achievements through community Achievements through community based interventionsbased interventionsNutrition indicators have also

improved

Achievements through community Achievements through community based interventionsbased interventionsFCHVs have been instrumental in

expanding services in the community

Achievements through community Achievements through community based interventionsbased interventionsFCHVs have been instrumental in

increasing the access of MNCH services

Motivation factors for Motivation factors for CHWsCHWsMCHWs and AHWs meeting the

educational qualification requirement have been promoted to senior AHWs and ANMs.

MCHWs and VHWs are the only health workers who receive DSA and TA

for conducting out reach clinics every month.

Motivation factors for Motivation factors for FCHVsFCHVsEstablishment of FCHV fundDress allowanceIncentive NPR 10,000 for timely

retirementcommunity recognition-

◦3 FCHVs who are nominated as the parliamentarian members.

◦well respected among the community.

ChallengesChallengesThe main function of VHWs was on Immunization.

With MoHP decision to promote the VHWs to Senior AHWs, they do not want to provide the immunization services anymore which has huge implications to the program.

FCHVs are utilized by many programs (not only heatlh) to reach the community and are incentivized. This might hamper the overall spirit of volunteerism in future

Even old FCHVs are reluctant to retire which is having implications to the quality of the services they provide.

FCHVs are politically affiliated which is hampering their work.

FCHVs are vehicle delivering various program to the community

Challenges

• Deviation from volunteerism• Effective fund utilization• Coordination• Over complication of ward register• Voluntary and mandatory withdrawal

THANK YOU

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