Trend Analysis of FCHV Program in Nepal

Presented by: Group-B Amit Mishra (02) Amrit Dangi (03) Ashmita Chaulagain (07) Mohan Chapai (17) Samjhana Shrestha (31) Sujata Subedi (35)

INTRODUCTION


The FCHV Program in Nepal was initiated through the Family Health Division, Department of Health Services, Ministry of Health and Population for addressing 6 killer diseases of children under 5 years of age, high population growth rate, reproductive health, family planning, and low life expectancy in the year1988/1989 in order to:

 improve community participation  enhance the outreach of health services through local
women working voluntarily.


FCHV Program was initially started in 27 districts and later expanded to all 75 districts in a phased manner

Objectives of the FCHV program

 To develop self-help mechanisms among rural women by providing basic knowledge to them on primary health care and with special focus on mothers and child health care.  To enhance community involvement in primary health care through mobilization of local women and resources.  To promote community participation for the best utilization of available maternal, child health and family planning services.

FCHV


A FCHV is a woman, selected by local mother's group who provides basic health information and preliminary services on family planning, maternal, new born and child health and other health issues. At present, the cadre of FCHVs is 48,549 and 97 % of them are in the rural areas with at least one FCHV per ward.

FCHVs act as:

 frontline local health resources persons, bridging the gap between
government health care and rural communities

 voluntary health educators and promoters, community mobilizer,

referral agents and community-based service providers for utilization of available health services among community member. the

Major Activities of FCHVs

Program issues Core activities

Family Planning  Education and promotion regarding all family planning methods  Provision of pills and condom Maternal and Education in pregnancy and promotion of antenatal care, Newborn Health iron supplements and tetanus toxoid Provision of iron supplements and vitamin A to postpartum mothers Promotion of good newborn care practices Child Health Pneumonia treatment with cotrimoxazole and referral of serious cases . Treatment of diarrhea with ORS and zinc Distribution of high dose vitamin A and deworming tablets twice yearly to targeted children under age five Provide education and promotional services for other diseases(eg. HIV/AIDS, Tuberculosis etc)

Other Conditions

Positive Aspects of the Program

    

Government ownership Covered all 75 districts FCHV Information available (FCHV Data Base) Health service delivery reaches door to door. Increased access to and utilization of maternal and child health services at community level Enhanced community participation and empowerment of women FCHVs are seen as key players in the progress in reduction of:
under-five mortality from 142 in 1990 to 48 in 2009(UNICEF 2009)  475 per 100,000 live births in 1997 to 281 per 100,000 live births in 2006(NDHS 2006)

Challenges of the Program



Deviation from Volunteerism Increasing expectations of FCHVs, as more and varied programs wish to implement their interventions through FCHVs, which may have effect on voluntary nature of their work. Full Community Ownership: It is difficult for communities to take ownership o FCHVs but is necessary for long-term sustainability of the program.

STATEMENT OF THE PROBLEM



The lack of motivation and reward mechanism within the program has led to deviation of FCHVs from volunteerism and resistance towards the program strategies. Although the government has already initiated the FCHV Endowment Fund but FCHV program incentives package does not cover for all municipalities.

Has failed to gain popularity in urban slums and suburbs of cities.

High program demand for much community based interventions has created work over load for FCHVs Ageing and illiterate FCHVs, inadequate incentives for FCHV fund management, high program demand etc. all have created a detrimental effect on program sustainability.

PURPOSE OF THE STUDY

General Objective:  To study the trend of FCHV program in Nepal From FY 2063/64 TO FY 2066/67 Specific objectives: To study the trend of:  the number of pill cycle distributed by FCHVs.  the number of person receiving condom by FCHVs.  the number of ORS packet distributed by FCHVs.  the number of people served by FCHVs.  ARI and Diarrhea cases treated by FCHV from FY 2064/65 to FY 2066/67.

METHODOLOGY


Study Area: Covers the FCHVs of Nepal and their activities in household, community, sub-health post, health post and PHCC level. Study Duration: 15 April to 10 June 2011. Study Design: descriptive cross sectional type of study Data Collection Procedure: The data were collected through systematic review secondary sources, including research, internet, journals and various reports.

Data Processing and Analysis: The data were managed and analyzed in MS-EXCEL (Version 7) and expressed in bar charts using number and percentage. Limitation of the study: The study is solely based on secondary data.

FINDINGS

Source: Annual Report 2063/64 to 2066/67

Figure 1: Bar chart showing the trends in distribution of oral contraceptive pills by FCHVs from the year 2063/64 to 2066/67.

Source: Annual Report 2063/64 to 2066/67

Figure 2: Bar chart showing the trends in distribution of condoms by FCHVs from the year 2063/64 to 2066/67.

Source: Annual Report 2063/64 to 2066/67

Figure 3: Bar chart showing the trends in distribution of ORS by FCHVs from the year 2063/64 to 2066/67.

Source: Annual Report 2063/64 to 2066/67

Figure 4: Bar chart showing the trend in the number of people served by FCHVs from the year 2063/64 to 2066/67.

Source: Annual Report 2064/65 to 2066/67

Figure 4: Bar chart showing the trends in ARI and Diarrheal cases treated by FCHVs from the FY 2064/65 to FY 2066/67.

CONCLUSION


FCHV program with its dedicated female health volunteers offering basic health services at the grass root level has been a lifeline in Nepal bringing government health services closer the communities. Steady increment in distribution of oral contraceptives pills by FCHVs over the past four fiscal years has been observed. Fluctuating trend in distribution of condoms by FCHVs has been observed with gradual decrement from FY 2063/64 to FY 2065/66 while a marginal increment in FY 2066/67.

CONTD.


A remarkable increment in ORS distribution by FCHVs has been observed clearly indicating FCHVs to be the most important health care providers for promoting ORS for the treatment of diarrhoea. The trend in number of people who contacted FCHVs for health services has been found accelerating in each successive year. A consistent increment in the percent of ARI and Diarrhoeal cases treated by FCHVs has been reported from FY 2064/65 to FY 2066/67.

RECOMMENDATION
Role of FCHVs should be further strengthened for increasing condom distribution. Sustaining the present achievement in delivery of health services such as pills distribution ORS packet distribution etc. gained through FCHVs.

REFERENCE

Annual Report of Department of Health Services- DoHS 2063/64 to 2066/67. National Female Community Health Volunteer Program Strategy, 2010.