1. Strengthening Nepal’s Female
Community Health Volunteer
Network through Public Sector
Accompaniment: Experiences at
Two Years
Dr. Bibhusan
Basnet, MBBS

2. AUTHORS
 Dan Schwarz, MD, MPH
 Ranju Sharma
 Chhitij Bashyal, MPA
 Ryan Schwarz, MD, MBA
 Ashma Baruwal, MPH
 Gregory Karelas, MSc
 Bibhusan Basnet, MBBS
 Nirajan Khadka
 Jesse Brady, MS
 Zach Silver
 Laura Corlin
 Joia Mukherjee, MD, MPH
 Jason Andrews, MD, SM, DTM&H
 Duncan Smith-Rohrberg Maru, MD, PhD

3. CHALLENGES
 Community health workers (CHWs) are key
components to public sector health systems in
many LMIC’s.
 Key components of effective CHW programs:
- Consistent oversight
Continuing education
Monitoring and evaluation,
Compensation for work
 No consensus on best practices, and empirical
data are lacking

4. NEPAL
SCENARIO
 The Nepal MOHP began its Female Community
Health Volunteer (FCHV) program in 1988
 FCHVs are recruited from each Village
Development Committee , and are trained to
provide community health services with a focus
specifically on immunizations, vitamin A
supplementation, and maternal-child health
 Total work force:48,680 FCHVs
 Each FCHV serves approximately 50 households

5. PROGRAM SETTING
 Nyaya Health in association with MOHP: Bayalpata
Hospital, in the remote western district of Achham,
Nepal
 Nyaya Health and the Ministry began a pilot program
to strengthen FCHV work in villages
 Currently works with 92 FCHVs in 9 VDCs serving a
total population of over 20,000
 Program evaluation over two year period:
- Expansion
- FCHV encounters
- Program cost

6. INTERVENTION
 Centralized Leadership Structure
- Nyaya’s CHWL facilitate FCHV work
- CHWLs and FCHVs overseen by the DCH once
a week
 FCHV compensation
- Financial Incentives: FCHVs receive NR 200
(USD $2.25) for weekly responsibilities
(approximately 8-12 hours of work per week)
- Non-financial incentives :Weekly meeting
lunches
Uniforms
Health equipment
supplies and
Community
recognition

7. Continued..
 Weekly Village-level FCHV Meetings
-CHWLs conduct weekly meetings with their
village’s FCHVs
-Review patient encounters with in-depth
discussions
-CHWLs subsequently review this information
with the DCH during weekly DCH-CHWL meetings
- Receive feedback from the DCH and hospital
clinical staff
- Convey back to the FCHVs

8. Continued..
 Weekly Village-level FCHV Trainings
-Thirty minute weekly trainings to the
FCHVs via CHWLs on certain topics and skill
-Bi-monthly training to the FCHVs at the
hospital
 Weekly Monitoring and Evaluation
-CHWLs collect FCHV data regarding weekly
patient encounters
-Evaluated by the DCH to monitor trends and
provide feedback to CHWLs and FCHVs in each
village
- Data communicated back to the community
and hospital staff at the month end

9. PROGRAM OUTPUTS
 Expansion:
-Three to nine villages
- High attendance rate(99%) at weekly FCHV-
CHWL meetings
- Average of 183 patient encounters per
village/month
 Program Costs:
- Total cost : NR 2,709,995 (USD $30,111) of
which
- Financial compensation:
FCHVs: 45%
CHWLs: 19%
DCH and CHD staffs: 31%
Administrative costs:5%
- Financial cost in patient served per annum :NRs
154 (USD $1.72) per encounter

10. Continued..
•Encounters
:
Matern
al
Health
22%
HIV
Others and TB
54% 4%
Family
Pediatri New
cs
Planning
Pregnan 11%
20%
Newcy
Birth4%
5%
Abortion
2%
Post-
natal Ante-
11% natal
67%

11. Pediatrics Encounter
ARI
22%
CMA
M
3%
Diarr
hea
75%

12. Some verbatim reports from
FGD’S with the FCHV’s
 Whenever someone is ill in our
community, they come looking for us first. It's
a matter of pride for us to be taking care of
our neighbors and community members
 “Even when we have household work to
do, we go when they call us for something
that we must attend to .”

13. FGD’S with the FCHV’s
 “We learn great things at the health post.
However, the topics taught at Bayalpata Hospital
and the ones discussed at our weekly meetings
are different than what we are taught at the health
post. We are taught new things at Bayalpata
Hospital.”
 “Previously, we used to submit reports at the
health posts once a month; sometimes we met
our fellow FCHVs and other times we did not.
Now we all sit together and discuss our work at
least once a week and learn new things.”

15. THANKYO
U

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