FCHVs contribute to women leadership in local level

Shamila Lamichhane

volentorFemale Community Health Volunteers (FCHVs), clad in light blue sari with a dark-blue work bag hanging by the shoulders are seen working in the forefront of primary health care services in every ward of the country. The FCHV Programme was commenced as a national programme by the government in 1988. Currently, there are 51,416 FCHVs in the country, with 46,088 in the rural areas and 5,328 in the urban areas.
According to Uma Gautam, an FCHV of Kathmandu Metropolitan City’ (KMC) Ward 9, FCHVs are selected from among the local married women, by the Ward’s local Mothers’ Group.
An 18-day basic training is provided to the selected women, she added.
The FCHVs mainly serve the expecting mothers in the villages and communities with the help of a medical toolkit they carry that generally includes a thermometer, tape, bandage, family planning commodities and oral rehydration solution (ORS).
They get these supplies replenished by filling out a form and submitting it to the nearest health post or an urban health clinic of the local-level body they are affiliated with. The FCHVs record their daily/weekly activities in a register and report it on a monthly basis to the government health facilities located in their catchment area.
According to the Nepal Family Health Programme Technical Brief, the FCHVs act as a bridge between the communities and the national health care system. The FCHVs are primarily involved in promotive and preventive services that include counseling and awareness regarding maternal, newborn and child health care, immunisation, nutrition, HIV/AIDS, hygiene and sanitation, etc.
Besides, they provide simple remedies like zinc tablets and ORS for diarrhea, vitamin A capsules and deworming tablets for children, as well as preliminary treatment of pneumonia in children, and distribution of iron tablets to the pregnant and new mothers.
The FCHVs keep track of and assist the pregnant women in their communities to visit the nearest health facilities for antenatal and postnatal check-ups and institutional deliveries. They also provide counselling on early recognition of danger signs and referral to the higher level health facilities. The government is also planning to mobilise FCHVs for the mitigation of non-communicable diseases in upcoming days.
Besides, the FCHVs actively participate in social and community affairs. They are involved in local level development activities of the community based organisations (CBOs), NGOs and INGOs, saving and credit cooperatives, community forest users groups, agriculture groups, and country-wide initiatives for social reform such as declaration of ‘Open Defecation Free’ areas. “I am also a trainer of terrace farming, a participant of the Bagmati Clean-up Campaign, and stray dogs’ management programme” said FCHV Gautam.
The FCHV programme has also contributed to women leadership development at the local level, which, in turn, has played a greater role in gender empowerment. The wider recognisation of their voluntary contribution, leadership skills and popularity in the communities were also reflected in the 2017 local level election, which saw many FCHVs being contesting and eventually being elected at the local levels
“Learning about health issues was something I found useful for myself. So, I thought I could benefit others from sharing the information and creating awareness”, said Laxmi Pradhan, an FCHV of Ward Number 1 of Kirtipur Municipality.
Similarly, Laxmi Maharjan, another FCHV of Ward Number 1 and 2 of Kirtipur Municipality, said that the opportunity to raise awareness amongst people about health issues and contribute to bring about a change in her own community was what motivated her.
The FCHVs are provided a yearly festival allowance of Rs.5, 000 and annual dress allowance from the government. Besides, many times they also receive some transportation support and snacks when they attend the programmes run by CBOs and NGOs at the local levels. Both Maharjan and Pradhan said that talks had been going on with the local government of Kirtipur to provide incentives to the FCHVs on a monthly basis when they go to submit their monthly report.
Meanwhile, FCHV Gautam said, “As a woman, it’s difficult to manage time out of household chores and the situation is even more complicated when you are involved in volunteering work. “It was difficult for me to convince the family members of my interest in volunteering works initially. But eventually, with some compromises, things worked out,” she said.
She further said that it was difficult to meet people due to busy life in the city and oftentimes people even ignored the concerns of the FCHVs like her.
The FCHVs have played a crucial role in elevating the national health indicators of the country and it is not a wonder why they are highly credited for contributing to Nepal’s success in achieving the 4th and 5th Millennium Development Goals: the reduction in child mortality rate and improvement of maternal health
. In a time span of 25 years, from 1990 to 2015, Nepal succeeded in reducing the mortality rate of children under 5 from 140.4 deaths per 1000 live births to 33.7 deaths. Similarly, the FCHVs were instrumental in bringing down the maternal mortality rate (MMR) from 850 deaths per 10000 live births in 1990 to 258 deaths in 2015.
Now that Nepal has adopted the federal structure, there lie newer opportunities for the local governments to utilise the potentials of the FCHVs and enhance their scope of works as per the local needs. Maharjan and Pradhan said that the locals and the local government of Kirtipur Municipality were receptive of their services and ideas. They further acknowledged that the Municipality was working hard to ensure to expand reach of health services to its residents.
Recently, glucometer and blood pressure measurement instruments were provided to the FCHVs. Besides, the Municipality regularly conducts surveys related to health issues, welfare of elderly citizens and any other things that might be beneficial to the community. 

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