FCHV Programme

BACKGROUND

The following major health problems are causing adverse effects on the health of the people of Nepal: high infant and maternal mortality, high population growth rate, poor sanitation, and lack of awareness of health needs. To combat these problems, the government established health institutions in all parts of the country, and in 1977 initiated the Community Health Leader Programme. Community health leaders (5,600 volunteers, mostly male) were trained in 16 districts.

However, recognising that most health problems are related to women and children, it became imperative that the female population be involved in primary healthcare activities. In FY 2045/46 (1988/89) the government revised its policy and initiated the community-based Female Community Health Volunteer (FCHV) Programme. It was first started in all the 19 districts of the Central Region and eight districts of the Mid-Western Region. It has been expanded to all districts of the country. Initially, the target was to select one FCHV per ward regardless of the population size. In 1993, the selection criteria changed from ward-based to population-based. According to the current strategy, there is to be one FCHV for every 400 population in the Terai, 250 in the hills and 150 in the mountains. However, regardless of population size, there must be one FCHV per ward. The population-based programme has been implemented in 28 districts.

After the completion of 15 days of initial training, FCHVs are provided with a drug kit free of cost, consisting of paracetamol, gentian violet, cotton, bandages, scissors, a soap case with soap, and a towel-all of which are to be replenished locally. However, oral rehydration solution packets, pills, and condoms are distributed free and are to be re-supplied by the concerned health institutions before stocks finish. The FCHVs are also provided with manuals, flip charts, recording and reporting formats, IEC materials, FCHV bags, signboards and badges.

The role of the FCHVs is mainly to focus on motivation and education of local mothers and community members for the promotion of safe motherhood, mother and child health, family planning, and community health. With the support of health personnel from the SHPs, HPs, and PHCCs, the FCHVs are expected to promote available health services, such as immunisation, family planning, and control of diarrhoeal diseases. Additionally, the FCHVs distribute pills, condoms, ORS packets and vitamin A capsules; and, in selected programme districts, they treat and refer ARI cases.

OBJECTIVES

The overall objectives of the Female Community Health Volunteer Programme are:

• to empower local women with basic knowledge of primary health care, especially related to the health of mothers and children;
• to enhance community self-help in primary health care through increased knowledge and mobilisation of local women and other resources;
• to promote community participation by creating awareness of the maximum utilisation of available health and family planning services in order to reduce infant, child and maternal mortality and the fertility rate; and,
• to create community awareness of public health issues.

STRATEGIES

Programme Planning and Staff Development Activities

• National Programme and Review Meeting
• Regional Programme Planning and Review
• Master Trainers Training for RHD/DHO Staff
• Training of Trainers for DHO/HP Staff

Community Orientation and Mobilisation

• DDC (District Development Committee) orientation
• VDC (Village Development Committee) orientation
• Mothers Group orientation

FCHV Selection and Training

• Mothers Group formation on the basis of population
• Selection of FCHVs
• Training of FCHVs

VDC-Level FCHVS

• Orientation of VDC-level FCHV Co-ordinator activities
• Selection of VDC-level FCHV Co-ordinators
• Training of VDC-level FCHV Co-ordinators

Support and Follow-Up Activities

• District Review Meetings
• FCHV Refresher/Review Meetings
• Provision of training materials
• IEC materials
• FCHV drug kits
• Recording and reporting

Other Programme Activities

• Selection of best FCHVs for exchange visit programme
• Selection of best FCHVs for reward