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. 2017 Sep 4;17(1):623.
doi: 10.1186/s12913-017-2567-7.

The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study

Sarita Panday  1 , Paul Bissell  2 , Edwin van Teijlingen  3 , Padam Simkhada  4
Affiliations

The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study

Sarita Panday et al. BMC Health Serv Res. .

Abstract

Background: In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai.

Methods: Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis.

Results: All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers' group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs.

Conclusions: Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings.

Keywords: Community health workers; Female community health volunteers (FCHVs); Hill; Maternal health; Nepal; Primary health care; Resource-poor countries; Rural; Terai.

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Conflict of interest statement

Ethics approval and consent to participate

The study received ethical approval from the Nepal Health Research Council. Participants were told that they would not be identifiable once the interviews were transcribed. In some cases, informed consent was obtained verbally, since some participants were illiterate. In focus groups, the participants were advised at the initiation of the session that what was discussed within the group was not to be shared outside of the group.

Consent for publication

Not applicable.

Competing interests

The author declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Summaries of Female Community Health Volunteers’ (FCHVs) maternal health services
See this image and copyright information in PMC

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