Female health volunteers of Nepal: the backbone of health care

Kandel, Nirmal; Lamichhane, Jaya

doi:10.1016/s0140-6736(19)30207-7

Cited by 34 publications

(30 citation statements)

References 6 publications

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“…FCHVs visited households with pregnant women or mothers with children under ve years to collect regular updates on the health status of the mother and the child and to communicate with them about the risk of COVID-19. These ndings are supported by the fact that FCHVs have been established as 'community infrastructure' in Nepal's health care system, especially in rural settings for the past three decades in achieving Millennium Development Goals (MDGs) [19]. However, during the interaction with FCHVs in this study, their major grievances were around how they lacked adequate knowledge on COVID-19 to assist community members in addition to limited or no access to PPE, and lack of incentives or daily allowances.…”

Section: Discussionmentioning

confidence: 99%

“…Female community health volunteers (FCHVs) are frontline health cadres at the community level [19]. In the communities, FCHVs are supported by outreach clinics, urban health clinics, and health promoters [20].…”

Section: Health Care Structure In Nepalmentioning

confidence: 99%

“…You know it (COVID-19) is contagious and at the beginning, people were not aware of how to protect from this disease. One of my relative was infected with COVID-19, he was very afraid.…”

mentioning

confidence: 99%

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Impact of COVID-19 on Health Services Utilization in Province-2 of Nepal: A Qualitative Study Among Community Members and Stakeholders

Singh

Sunuwar

Shah

et al. 2020

Preprint

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Background The COVID-19 pandemic is posing unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aims to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal. MethodsThe semi-structured qualitative interviews were conducted among purposively selected participants (n=41) from a mix of rural and urban settings in all districts (n =8) in Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro. ResultsThe findings of this research are categorized into four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and, iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and fearful about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions of health services were mostly due to the closure of health services at local health facilities, limited involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from governments at all levels towards health services management during the COVID-19 pandemic. ConclusionsThis study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is essential to expand the service coverage and its quality in addition to increasing public-private sector engagement to ensure the essential health services are utilized by the population.

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Section: Discussionmentioning

confidence: 99%

Section: Health Care Structure In Nepalmentioning

confidence: 99%

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Impact of COVID-19 on Health Services Utilization in Province-2 of Nepal: A Qualitative Study Among Community Members and Stakeholders

Singh

Sunuwar

Shah

et al. 2020

Preprint

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“…as their role has evolved and expanded over time (Kandel & Lamichhane, 2019;Khatri, Mishra, & Khanal, 2017). It is critical that any future iterations of GMP capitalize on this enabling dynamic, providing frontline workers with the support and training needed to deliver quality counselling.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to growth monitoring and promotion in Nepal: Household, health worker and female community health volunteer perceptions

Pollifrone

Cunningham

Rana

et al. 2020

Maternal & Child Nutrition

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Growth monitoring and promotion (GMP) is both a service for diagnosing inadequate child growth in its earliest stages and a delivery platform for nutrition counselling. The widespread use of GMP services in developing countries has the potential to substantially reduce persistent child undernutrition through early diagnosis and by linking caregivers and their children to key health and nutrition services. However, researchers have questioned the effectiveness of GMP services, which are frequently undermined by underdeveloped health systems and inconsistent implementation. This analysis examined both supply‐ and demand‐side factors for GMP utility in Nepal from the perspectives of beneficiaries and service providers, particularly focusing on three components of GMP: growth assessment, analysis of growth status and counselling. The most common factors influencing GMP uptake included beneficiaries' perceptions of the relative importance of GMP and the knowledge and skill of frontline workers. Both providers and beneficiaries viewed GMP as a secondary health and nutrition activity and therefore less important than curative services. We found deficits in GMP‐related knowledge and skills among providers (i.e. health workers and female community health volunteers), as well as indications of poor training quality and coverage. Furthermore, we found variation in GMP utilization by maternal age, education and residency (alone, nuclear or extended), as well as household socio‐economic well‐being and rurality. This study is the first to assess factors influencing both beneficiaries and service providers for GMP utilization. Further research is needed to explore the implementation of improved GMP protocols and to evaluate facility‐level implementation barriers.

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“…15 16 A wealth of evidence base from the LMICs including Nepal shows that mobilising trained community health workers (CHWs) is effective in delivering health education, early detection, case management and lifestyle interventions required to manage NCDs in the community. [17][18][19] In Nepal, CHWs are the backbone of public health systems, 20 which also led to achieving Millennium Development Goals. 21 CHWs in Nepal can be divided into two groups: the first group comprises of auxiliary health worker, community medical assistant, auxiliary nurse midwife, health assistant and staff nurse, who undergo certified training courses to provide preventive and basic health services.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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

Rawal

Kharel²,

Yadav

et al. 2020

BMJ Open

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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.

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Female health volunteers of Nepal: the backbone of health care

Abstract: We declare no competing interests. We thank all the female community health volunteers in every ward and village in Nepal.

Cited by 34 publications

References 6 publications

Impact of COVID-19 on Health Services Utilization in Province-2 of Nepal: A Qualitative Study Among Community Members and Stakeholders

Impact of COVID-19 on Health Services Utilization in Province-2 of Nepal: A Qualitative Study Among Community Members and Stakeholders

Barriers and facilitators to growth monitoring and promotion in Nepal: Household, health worker and female community health volunteer perceptions

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

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