1. Dr Naresh Pratap K C Department of Health Services MoHP
Community Health Workers Meeting
Dr Naresh Pratap K C Department of Health Services MoHP

2. Milestone 1991:First Health Policy after Democracy
National Health Policy 1991
1991:First Health Policy after Democracy
to improve mainly RH services, family planning, safe motherhood, child health and communicable disease services
International Conference on Population and Development
1994
Nepal was one of the signatory indicating our commitment to RH rights
Millennium Development Goals
2000
Nepal was one of the signatory, joined hands with rest of the world , committed to bring changes in the health of the people .

3. National Health Policy (1991)
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.
Restructuring of Health System(79 hospitals, 178 PHCCs, 705 HP and 3132 SHPs)
Establish special cadre MCHW to provide MCH services at the community level.
VHWs to provide immunization services.

4. Female Community Health Volunteer (FCHV)Program
Recognizing the importance of women’s participation in health promotion, GoN Initiated FCHV program in 1988/89
Pillars to Nepal’s Public Health Programs
Numerous external developmental partners and NGOs share their implementation level expertise and on going support to the program

5. Community Health Workers in Nepal
Health Care Workers
Maternal and Child Health Workers (MCHW)
Village Health Workers (VHW)
Trained Birth Attendant (TBA)- are not recognized by Government since 2004
Volunteers
Female Community Health Care Volunteers (FCHV)-

6. Community Health Workers
MCHWs (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

7. Role of Maternal and Child Health Workers
Conduct Delivery
Conduct PNC
Care of Newborn
Supply FP commodities
BCC
Management of diarrhoea and pneumonia in the community under CB-IMCI
Supervision of FCHVs
Referral Services

8. Role of Village Health Workers
Immunization services
Management of Newborn Infections
Supervision of FCHVs

9. Community Health System
FCHV
Settlement
Settlement
Each VDC has nine wards & 1 health facility 1 2 3 5 7 4 9 6 8
Mothers group
Settlement
District is divided into VDCs
Each ward has:
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
Female Community Health Volunteers, who are about 52,000 in numbers, are the front-line cadres working at community level. They are providing various community based services mainly in educating, counseling, distributing FP/RH commodities and referring the clients to the health facilities. They are well accepted and recognized at the community level for Integrated Management of Childhood Illness, Community Based Neonatal Care, Birth Preparedness and several community based activities related to health.
At least one FCHV is available in each ward, the lowest political unit of Nepal, which offered the opportunity to educate families, distribute misoprostol and followup postpartum.
75 districts in Nepal

10. Female Community Health Volunteers
FCHVs are involved in:
Maternal and Neonatal Health
Family Planning programs
PP Vitamin A and iron tablet distribution
Awareness on maternal and neonatal health
Provide essential neonatal care during birth and postnatal
Child health
Vitamin A distribution & de-worming
Community based management of pneumonia & diarrhea
Awareness on Immunization programs

11. Role of Female Community Health Workers
Demand generation in the community for MNCH services
Counseling to Pregnant women and family on birth Preparedness
Community based management of pneumonia & diarrhea
Management of newborn infections, birth a in the community under CB-NCP program
Behavior Change Communication
Distribution of FP commodities (condom and pills)
During NIDs- Administration of Polio drops
Referral services

12. Achievements through community based interventions
NDHS 2001, 2006 and 2011 have revealed significant improvement in Child Health indicators.

13. Improving Maternal & Child Health in Nepal
Dramatic declines in child mortality
Improvements in maternal health
TFR dropped to 2.6
MMR from 539 to 281 (DHS ,2006)
Most women in Nepal still deliver at home (64%) and without a skilled provider (65%)
NMR remains unchanged: Estimated 32,000 newborn deaths/year during their first month—most in first week
Source: NDHS

14. Achievements through community based interventions
FCHVs are extensively counseling and raising awareness in the community for institutional delivery through Birth Preparedness Package

15. Achievements through community based interventions
Nutrition indicators have also improved

16. Achievements through community based interventions
FCHVs have been instrumental in expanding services in the community

17. Achievements through community based interventions
FCHVs have been instrumental in increasing the access of MNCH services

18. Motivation factors for CHWs
MCHWs 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.

19. Motivation factors for FCHVs
Establishment of FCHV fund
Dress allowance
Incentive NPR 10,000 for timely retirement
community recognition-
3 FCHVs who are nominated as the parliamentarian members.
well respected among the community.

20. Challenges
The 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.

21. FCHVs are vehicle delivering various program to the community21

22. Challenges Deviation from volunteerism Effective fund utilization
Coordination
Over complication
of ward register
Voluntary and
mandatory withdrawal 22

23. THANK YOU

24. Feedback Nepal: tasks and roles