An Analytical Report on National Survey of Female Community Health Volunteers of Nepal
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An Analytical Report on National Survey of Female Community Health Volunteers of Nepal New ERA ACKNOWLEDGEMENTS We are grateful to ORC Macro International Inc. /Washington D.C. and USAID/Nepal for entrusting New ERA to undertake this National study of Female Community Health Volunteer in all districts of Nepal. We are indebted to Dr. Pav Govindaswamy, Senior Country Coordinator from Macro International Inc., Calverton, Maryland, USA for the overall guidance and technical support she provided during the implementation of the survey and her advice and suggestions in the finalization of this report. The study team is grateful to Dr. John Quinley, the then Health and Child Survival Advisor and Mr. Dharma Pal Raman of USAID/Nepal for providing support in designing the survey instruments. The team is also thankful to Mr. Bharat Ban, Monitoring and Evaluation Specialist, NFHP, for his professional advice in the survey design, survey implementation and finalization of the study. We would also like to thank Mr. Dilip Poudel and all the other concerned personnel of NFHP for their support and cooperation. The study team would like to thank Dr. Bal Krishna Suvedi, Dr. Pyiush Kumar Ragendra, Mr. Bhogendra Dottel and Ms. Mangala Manandher of the Family Health Division, Ministry of Health and Population for the support and cooperation they provided during the entire study period. We would also like to express our gratitude to all the District Health Officers for their cooperation during the survey period. Last but not least, we would like to express our heartfelt gratitude to all the respondent FCHVs for their co-operation provided to our field researchers. This report would not have been possible without their generous support. ~ New ERA Study Team i FOREWORD Female Community Health Volunteers (FCHVs) program was formulated in 1988. Several revisions were made in the program in response to the changing context of health and development in Nepal. The FCHV program is basically designed to promote health through interfering the community and the health institution and/or health workers in the public sectors. The FCHV program focuses on family planning, maternal/neonatal and child health. Vitamin A distribution program. The activity of FCHV is contributing to Nepal’s goal of reducing the total fertility rate and under five mortality and maternal mortality rates. There are about 50,000 FCHVs who have been contributing in the attainment of uplifting of health status of women and children of Nepal. It is gratifying to note that a detailed and nationally representative survey of Female Community Health Volunteers of Nepal has been carried out first time. It attempts to give a nationally representative and district specific picture of the FCHV program including their personal characteristics, their interactions with their communities and with local health services and their contribution to the major health programs of the Ministry of Health and population. It is obvious from this report that the contribution of FCHV in the development of health status has been significant. On behalf of the Family Health Division/DoHS. I would like to deeply appreciate the work of FCHVs and bow to the volunteerisms spirit they have. I hope this report will help in further developing policy issues and formulate future programs. The Family Health Division would like to extend sincere thanks to USAID/ ORC Macro International for providing financial and technical supports and New ERA for completing this survey. I would like to thank all concerned institutions and persons who have contributed in this study. Dr. Bal Krishna Suvedi Director Family Health Division Ministry of Health, Nepal ii ABBREVIATONS ANC Antenatal Care ARI Acute Respiratory Infection BCC Behavior Change Communication BPP Birth Preparedness Package CARE CARE International CB-IMCI Community-Based Integrated Management of Childhood Illness CPD Core Program District DACAW Decentralized Action for Children and Women DHS Demographic Health Survey FCHV Female Community Health Volunteer FM Frequency Modulation HIV/AIDS Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome HMIS Health Management Information System HP Health Posts ID Identity Card IMNMP Intensification of Maternal an Neonatal Micronutrient Program INGO International Non-Governmental Organization IPC Inter Personal communication MCHW Maternal and Child Health Worker MOH Ministry of Health NFHP Nepal Family Health Program NGOs Non Governmental Organization NTAG Nepali Technical Assistance Group ORC Out Reach Clinics. ORS Oral Dehydration Solution ORT Oral Dehydration Therapy PHC Primary Health Clinics PLAN PLAN International PLIC Protecting Livelihood in Crisis SHP Sub Health Posts TBA Traditional Birth Attendant UNICEF United Nations Children's Fund USAID United States Agency for International Development VDC Village Development Committee VHW Village Health Worker iii TABLE OF CONTENTS Page ACKNOWLEDGEMENTS i FOREWORD ii ABBREVIATIONS iii TABLE OF CONTENTS iv LIST OF TABLES vi LIST OF FIGURES vii EXECUTIVE SUMMARY viii Chapter - I: INTRODUCTION 1 1.1 Background and Objectives 1 1.2 FCHV Activities 1 1.3 Village Development Committee (VDC) and Municipal FCHVs 2 1.4 Population and Ward Based FCHVs 3 1.5 Survey Implementation 5 Chapter - II: FCHV CHARACTERISTICS 7 2.1 Age of FCHVs 7 2.2 Education and Literacy 7 2.3 Caste and Ethnicity 9 2.4 Length of Service and Turnover Rates 10 2.5 Workload and Attitudes Towards Work 12 2.6 Serving the Disadvantaged 13 Chapter - III: FCHV SUPPORTS 16 3.1 Sources of Information for FCHVs 16 3.2 Supervision, Meetings, Reporting and Training 17 3.3 Exposure to Media Programs 20 3.4 Community Supports 22 Chapter - IV: FAMILY PLANNING, HIV, OUTREACH CLINICS AND FIRST AID 25 4.1 Family Planning 25 4.2 HIV/AIDS 28 4.3 Outreach Clinics 29 4.4 First Aid 29 Chapter - V: MATERNAL AND NEWBORN CARE 31 5.1 Counseling in Pregnancy 31 5.2 Iron During Pregnancy 33 iv Page 5.3 Delivery and Newborn Care 34 5.4 Post-Partum Visits and Vitamin A 36 Chapter - VI: CHILD HEALTH 38 6.1 CB-IMCI: Community-Based Integrated Management of Childhood Illness 38 6.2 Diarrhea Care 44 6.3 Vitamin A and De-worming Mass Distribution Program 46 6.4 Routine Immunizations and Polio National Immunization Days 47 ANNEXES Annex 1: Study Team Members Annex 2: Questionnaire Annex 3: Survey Tables v LIST OF TABLES Page Table 1.1: Number of FCHVs in VDCs and Municipalities and Their Supports 2 Table 1.2: Summary Information on Ward and Population Based FCHV Programs 3 Table 1.3: Additional FCHVs Needed to Reach New Population Based Guidelines 4 Table 1.4: Completion of Surveys and Reasons for Non-completion 5 Table 2.1: Literacy versus Education in FCHVs 7 Table 2.2: Education of FCHVs vs. All Women by Age Group 7 Table 2.3: Literacy and Job Performance 9 Table 2.4: Work Hours and Attitudes Towards More Work 13 Table 3.1: FCHV Supervision 17 Table 4.1: Skills Mentioned by FCHVs 27 Table 4.2: FCHV Knowledge of HIV/AIDS Compared to Women and Men 28 Table 5.1: FCHV Catchments Population and Proportion of Pregnant Women Counseled 31 Table 5.2: FCHV Catchment Population and Proportion of Annual Expected Births Recalled 32 Table 5.3: Advice Given During Pregnancy 33 Table 5.4: FCHV Knowledge of Danger Signs in Pregnancy 33 Table 5.5: IMNMP and FCHVs Providing Iron to Pregnant Women 33 Table 5.6: FCHVs Present at Deliveries by TBA Status 35 Table 5.7: Essential Newborn Care FCHV Recommendations vs. Actual Practices 36 Table 6.1: Goods for Community Pneumonia Treatment 39 Table 6.2: Treatment of Childhood ARI in Nepal (DHS 2006) 40 Table 6.3: Pneumonia Treatments in the Six Months Prior to the Survey 41 Table 6.4: Summary of CB-IMCI Care Per FCHV 43 Table 6.5: Districts by Proportion of Treatment FCHVs 43 Table 6.6: Comparison of Treatment and Referral FCHV Activities (20 districts) 44 Table 6.7: Treatment of Childhood Diarrhea in Nepal (DHS 2006) 45 Table 6.8: FCHVs Having ORS and Providing Diarrhea Treatments in the Past Month 45 Table 6.9: Diarrhea Treatments with ORS by FCHV Catchment Population 46 vi LIST OF FIGURES Page Figure 2.1: FCHVs by Age 7 Figure 2.2: FCHV Literacy by Caste/Ethnic Group 8 Figure 2.3: The Proportion of FCHVs by Ethnic/Caste Group Compared to Rural Population 10 Figure 2.4: Length of Service in FCHVs 11 Figure 2.5: FCHVs Workload by Households Covered and Geographic Zone 12 Figure 2.6: Distribution of Caste/Ethnic Groups in the Population and among Children with ARI seen by FCHVs in 33 CB-IMCI Districts, by FCHV Report 14 Figure 2.7: Distribution of Caste/Ethnic Groups in the Population and Among Pregnant Women 14 Figure 3.1: Main Source of Health Information for FCHVs 16 Figure 3.2: Participation of FCHVs Supervision, Meetings and Report by NFHP vs. Other Districts 18 Figure 3.3: FCHV Possession of Items Distributed at Basic Training by Years of Experience 19 Figure 3.4: Frequency of Listening to the Radio 20 Figure 3.5: Percentage of FCHVs Who have Listened to Specific Radio Programs in the Past Six Months 21 Figure 3.6: FCHV Community Supports 23 Figure 4.1: FCHVs with Pills and Condoms in NFHP Supported Districts 25 Figure 4.2: FCHVs Participation in Family Planning 27 Figure 4.3 Comparison of Knowledge of HIV/AID between Men, Women and FCHVs 28 Figure 5.1: FCHV Catchment Population and Proportion of Annual Expected Births Recalled 32 Figure 5.2: Coverage of ANC, FCHV Visits, Iron Supplementation and Coverage for 90 Days in INMNP versus Routine Districts 34 Figure 5.3: FCHV Knowledge of Essential Newborn Care 36 Figure 6.1: Goods for Community Pneumonia Treatment 39 Figure 6.2: Rate of Seeing Children with ARI vs.