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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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