Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study

Abstract

Background/objectiveThe increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal.DesignWe used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders’ consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically.SettingData were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level.ParticipantsWe conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6).ResultsThe CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation.ConclusionEngaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW’s capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.

A qualitative exploratory study of selected physicians’ perceptions of the management of non-communicable diseases at a referral hospital in Zimbabwe

“…Due to economic challenges in developing countries, financial challenges are common for NCD care providers in developing countries and the SSA region [ 2 , 7 , 8 ]. Doctors also highlighted perceived challenges related to patients’ behavior, which exposes them to higher NCD risks [ 4 ]. Behaviors identified in literature include absconding from treatment due to stigma or the inability to afford medication, as well as religious practices such as faith-healing beliefs resulting in medication abscondment [ 4 , 5 , 8 ].…”

“…Doctors also highlighted perceived challenges related to patients’ behavior, which exposes them to higher NCD risks [ 4 ]. Behaviors identified in literature include absconding from treatment due to stigma or the inability to afford medication, as well as religious practices such as faith-healing beliefs resulting in medication abscondment [ 4 , 5 , 8 ]. The study also revealed doctors’ perceptions of the existence of behaviors by patients, which compromise care delivery for NCDs [ 6 , 10 ].…”

“…The study also revealed doctors’ perceptions of the existence of behaviors by patients, which compromise care delivery for NCDs [ 6 , 10 ]. Patient behaviors and attitudes are common challenges in medicine whereby adherence to prescriptions is neglected and patients are sometimes unwilling to change behaviors such as smoking and alcohol abuse, despite the resultant exposure to undesirable effects such as NCD development [ 4 , 5 ].…”

“…NCDs are also a leading cause of premature death, 80% of which are in low- and middle-income countries (LMICs) [ 1 ]. The World Health Organization (WHO) also reported a 71% increase in morbidity and mortality related to NCDs, with more than 40.5 million deaths from the total 56.9 million global deaths recorded in 2016 being related to NCDs, three quarters of which were in LMICs [ 3 , 4 ]. The NCD burden is exacerbated in LMICs due to co-morbidities with the HIV burden [ 5 ].…”

Engaging Female Community Health Volunteers (FCHVs) for cardiovascular diseases risk screening in Nepal

“…Faced with the surging burden of CVDs and the limited numbers of health professionals in the country, more innovative approaches are needed to address the problem of CVDs. Evidence shows that the trained Community Health Workers (CHWs) could perform lifestyle interventions, improve medication adherence and manage various chronic conditions in community settings [ 16 – 19 ].…”