25 years of Nepal’s FCHV Program: Lesson Learned

Dr. Ram Kumar ShresthaCommunity health and Nutrition

Senior Quality Improvement AdvisorASSIST Project/URC

Ram Kumar Shrestha, Nepal

Mothers Group

Districts Health Office

H P

Health Post /Sub-Health Post

PHC

National FCHV Program, Family Health Division

VHW/MCHW

FCHV focal person

Problems with FCHV program before implementation of NVAP (1993)

• FCHV were not selected properly • Not all FCHVs received basic training • FCHV did not receive regular Refresher Training• HF did not consider FCHV as a part of their system• FCHV Supervision from HF was weak • FCHV did not receive financial support• FCHVs were not motivated• Continued addition of New tasks • Expected to visit all HHs

Surkhet

Bardiya

Dadeldhura

Dang

Kapilvastu

Kailali

Kanchanpur

Achham

Darchula

Bajura

Bajhang

Humla

DolpaKalikot

Jumla

Mugu

Sarla

hi

MorangSunsari

Jhapa

Tanahun

Manang

Mustang

ChitawanMakawanpur

RolpaSalyan

Rukum

Jajarkot

Dhad

ing

Gorkha

Nuwakot

RasuwaPyuthan

Udayapur

Okhaldhunga

Sankhuwasabha

SolukhumbuTaplejung

Palpa

Myagdi

Syangja

KaskiLamjung

Arghakhanchi

Gulmi

Baglung

Parb

at

Dailekh

Banke

Rupandehi

Doti

Baitadi

Nawalparasi

Parsa

Mah

ottar

i

Dha

nush

a

Siraha

Raut

ahat

Bara

Saptari

Sindhuli

Sindhupalchok

Kavrepalanchok

Ramechhap

Dolakha

Dhan

kuta

Khotang Bhojpur

Ilam

Terh

athu

m

PanchtharLegend:Legend:

PHASE I (October 1993)

PHASE II (April 1994)

PHASE III (October 1994) PHASE IV (April 1995)

PHASE V (October 1995)

PHASE VI (April 1996) PHASE VII (September 1996)

PHASE VIII (October 1997)

PHASE IX (April 1998)

PHASE X (October 1998) PHASE XI (April 1999)

PHASE XII (October 1999)

PHASE XIII (April 2000)

PHASE XIV (October 2000) PHASE XV (April 2001)

PHASE XVI (October 2001)

PHASE XVII (October 2002)

National Vitamin A Program, Nepal (1993 – 2002)Program spread to all districts by Phase

CHW

Approach – Community Health Worker

Current Situation of Community Health Workers

SUPPORT TO FCHV

FCHV Planning with multi-sectoral staff

• FCHVs play the leading role for message dissemination

• Interactive miking, magic shows, parades and theater performances and town criers are used

• Schools, police, local business groups, women’s groups, community leaders are mobilized

• Broadcast of vitamin A messages on radio and TV complements these promotion activities

Ram Kumar Shrestha, Nepal

MotivationMotivation is defined as the driving force behind our desire for something. It could either results from our desire for something that is internally driven (Intrinsic) or it could result from our desire for something outside (External Driven) of us.

TRUST

Motivation is Not Static but it is Dynamic in nature

Factors sustaining motivation of FCHV for more than 20 years

Hand-over of EF passbook to FCHVHand-over of EF passbook to FCHV

"Finally we have received some support for our hard work""Finally we have received some support for our hard work"

Achievements of FCHV program

91 89 89 90 91 9095 96 97 97 95 97 98

0102030405060708090

100

1 2 3 4 5 6 7 8 9 10 11 12 13

Number of Program Years

% o

f C

over

age

National Vitamin A ProgramAverage Capsule Coverage by the Number of the Years in Program (2007)Average Capsule Coverage by the Number of the Years in Program (2007)

0

10

20

30

40

50

60

70

1996 1997 1998 1999 2000 2001 2002 2003

Programme Districts Non-programme Districts

Community Based Treatment of Pneumonia

Proportion of Expected Pneumonia Cases Treated (%)

8,500 deaths averted each year8,500 deaths averted each year

Trend in Under-Five Mortality1986-2016

201

155

120

4356

7291

0

50

100

150

200

1981-86

1986-91

1991-96

1996-01

2001-06

2006-11

2011-16

De

ath

s p

er

10

00

liv

e b

irth

s Estimates

Based on DHS 1996

Based on DHS 2001

MDG = 54 deaths per 1000 live births by 2015

17

^Approximate numbers for illustrative purposes only

Coverage with ANC anemia interventions, Nepal DHS, 2001-2011

Indicator ZoneYear of Survey

2001 2006 2011

% attending ANC

Mtn/Hill 38^ 64^ 79^Terai 56 81 90National 49 75^ 85

% receiving any iron

Mtn/Hill 19^ 51^ 75^Terai 25 66 84National 23 61^ 80

% receiving dewormer

Mtn/Hill 15^ 52^Terai 25 58National 22^ 55

Next Steps

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

Community Health System

Community Committee

Ram Shrestha

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

CHW

Community Health System