Presentation on theme: "Dr Naresh Pratap K C Department of Health Services MoHP"— Presentation transcript:
1Dr Naresh Pratap K C Department of Health Services MoHP Community Health Workers MeetingDr Naresh Pratap K C Department of Health Services MoHP
2Milestone 1991:First Health Policy after Democracy National Health Policy 19911991:First Health Policy after Democracyto improve mainly RH services, family planning, safe motherhood, child health and communicable disease servicesInternational Conference on Population and Development1994Nepal was one of the signatory indicating our commitment to RH rightsMillennium Development Goals2000Nepal was one of the signatory, joined hands with rest of the world , committed to bring changes in the health of the people .
3National Health Policy (1991) Formulated to improve RH services where family planning, safe motherhood, child health and communicable diseases were identified as priority programs.Restructuring of the Health System,At least one health facility for one VDCBringing health services closer to the communityIntegration of vertical programs (preventive, promotional and curative)Introduction of new Cadre: Maternal and child health workers, maternal health being the priority program.Restructuring of Health System(79 hospitals, 178 PHCCs, 705 HP and 3132 SHPs)Establish special cadre MCHW to provide MCH services at the community level.VHWs to provide immunization services.
4Female Community Health Volunteer (FCHV)Program Recognizing the importance of women’s participation in health promotion, GoN Initiated FCHV program in 1988/89Pillars to Nepal’s Public Health ProgramsNumerous external developmental partners and NGOs share their implementation level expertise and on going support to the program
5Community Health Workers in Nepal Health Care WorkersMaternal and Child Health Workers (MCHW)Village Health Workers (VHW)Trained Birth Attendant (TBA)- are not recognized by Government since 2004VolunteersFemale Community Health Care Volunteers (FCHV)-
6Community Health Workers MCHWs (3134) and VHWs (4015) are employed by Government.Total of 48,549 FCHVs are currently present in Nepal. One FCHV per ward or one per 500 population
7Role of Maternal and Child Health Workers Conduct DeliveryConduct PNCCare of NewbornSupply FP commoditiesBCCManagement of diarrhoea and pneumonia in the community under CB-IMCISupervision of FCHVsReferral Services
8Role of Village Health Workers Immunization servicesManagement of Newborn InfectionsSupervision of FCHVs
9Community Health System FCHVSettlementSettlementEach VDC has nine wards & 1 health facility123574968Mothers groupSettlementDistrict is divided into VDCsEach ward has:households1 Female Community Health Volunteer (FCHV) who provides maternal and child care services in the community.A mother group coordinated by FCHV for community mobilizationFemale Community Health Volunteers, who are about 52,000 in numbers, are the front-line cadres working at community level. They are providing various community based services mainly in educating, counseling, distributing FP/RH commodities and referring the clients to the health facilities. They are well accepted and recognized at the community level for Integrated Management of Childhood Illness, Community Based Neonatal Care, Birth Preparedness and several community based activities related to health.At least one FCHV is available in each ward, the lowest political unit of Nepal, which offered the opportunity to educate families, distribute misoprostol and followup postpartum.75 districts in Nepal
10Female Community Health Volunteers FCHVs are involved in:Maternal and Neonatal HealthFamily Planning programsPP Vitamin A and iron tablet distributionAwareness on maternal and neonatal healthProvide essential neonatal care during birth and postnatalChild healthVitamin A distribution & de-wormingCommunity based management of pneumonia & diarrheaAwareness on Immunization programs
11Role of Female Community Health Workers Demand generation in the community for MNCH servicesCounseling to Pregnant women and family on birth PreparednessCommunity based management of pneumonia & diarrheaManagement of newborn infections, birth a in the community under CB-NCP programBehavior Change CommunicationDistribution of FP commodities (condom and pills)During NIDs- Administration of Polio dropsReferral services
12Achievements through community based interventions NDHS 2001, 2006 and 2011 have revealed significant improvement in Child Health indicators.
13Improving Maternal & Child Health in Nepal Dramatic declines in child mortalityImprovements in maternal healthTFR dropped to 2.6MMR from 539 to 281 (DHS ,2006)Most women in Nepal still deliver at home (64%) and without a skilled provider (65%)NMR remains unchanged: Estimated 32,000 newborn deaths/year during their first month—most in first weekSource: NDHS
14Achievements through community based interventions FCHVs are extensively counseling and raising awareness in the community for institutional delivery through Birth Preparedness Package
15Achievements through community based interventions Nutrition indicators have also improved
16Achievements through community based interventions FCHVs have been instrumental in expanding services in the community
17Achievements through community based interventions FCHVs have been instrumental in increasing the access of MNCH services
18Motivation factors for CHWs MCHWs and AHWs meeting the educational qualification requirement have been promoted to senior AHWs and ANMs.MCHWs and VHWs are the only health workers who receive DSA and TAfor conducting out reach clinics every month.
19Motivation factors for FCHVs Establishment of FCHV fundDress allowanceIncentive NPR 10,000 for timely retirementcommunity recognition-3 FCHVs who are nominated as the parliamentarian members.well respected among the community.
20ChallengesThe main function of VHWs was on Immunization. With MoHP decision to promote the VHWs to Senior AHWs, they do not want to provide the immunization services anymore which has huge implications to the program.FCHVs are utilized by many programs (not only heatlh) to reach the community and are incentivized. This might hamper the overall spirit of volunteerism in futureEven old FCHVs are reluctant to retire which is having implications to the quality of the services they provide.FCHVs are politically affiliated which is hampering their work.
21FCHVs are vehicle delivering various program to the community 21
22Challenges Deviation from volunteerism Effective fund utilization CoordinationOver complicationof ward registerVoluntary andmandatory withdrawal22