Approaches to Increase Availability of Quality Health Services Through Community Health Workers –Experiences From Nepal

Acharya, Baburam

Background: Nepal is among five countries to make tremendous progress in reducing infant and child mortality. Strong community-based approaches have increased access to services through Female Community Health Volunteers (FCHVs), a program established in 1988. This cadre established a community-based approach initially with distribution of family planning commodities, biannual distribution of vitamin A capsules and deworming tablets, and case management of pneumonia and diarrhea.

Strategic approach (Methods): Programmatic information from a variety of sources is used to demonstrate success with community-based programs with regard to coverage, compliance and quality of care. Sources include baseline and endline surveys for pilot programs, program and partner specific monitoring data, and routine Government data (HMIS), and the DHS reported trends in mortality.

Findings: FCHVs currently treat 60% of pneumonia cases recorded in the public sector. Their knowledge and skill on case management of pneumonia and diarrhoea is above 95%, and availability of key commodities is 80%. FCHVs have sustained more than 95% coverage of semiannual vitamin A supplementation and deworming over the past decade. Introduction of chlorhexidine and misoprostol has resulted in coverage over 60%. FCHVs interact with mothers for an estimated 60% of pregnancies, and with their counseling have improved neonatal practices such as early initiation of breastfeeding (from 57 % to 72 -78 % in selected districts), and through the NCP, have successfully referred 0.9% to 3% of low birth weight infants.

Conclusion: Maternal and child mortality rates decreased in Nepal, likely from a variety of causes. Over the past decade, even during a period of conflict, indicators of community-based service delivery are impressive. These services are based on controlled trials demonstrating mortality reduction, and are focused on the known primary causes of death. Most likely, these community based programs delivered by FCHVs, have contributed to the mortality reduction.