This is my first ever meeting with Female Community Health Volunteers (FCHVs). I have only heard about them till day but never got any opportunity to stay with them and have conversation. The objective was to enhance their capacity regarding their attitude towards young people’s SRHR especially regarding safe abortion services to young women. I really acknowledge their work and their positive attitude towards working with young people and improving their SRHR status.
Ministry of Health and Population in Nepal started Female Community Health Volunteer (FCHV) program in 1988 leading to a current total of nearly 52,000 FCHVs in Nepal and 97% of them are in rural areas. By 1999, the program was established in all 75 districts of Nepal.
FCHVs play an important role in contributing to a variety of key public health programs, including family planning, maternal care, child health, vitamin A supplementation/ de-worming and immunization coverage. They are the foundation of Nepal’s community-based primary health care system and are the key referral link between the health services and communities. The most glorious achievement have been made to women’s leadership and empowerment at the Village Development Committee (VDC) level, and several active FCHVs are as VDC members. Recently Government of Nepal mobilized FCHVs as Election Observers.
Recently I visited one of the rural areas of Nepal, Sugarkhal VDC in Kailali district. I met more than 50 FCHVs in a training regarding young people’s SRHR and Value Clarification activity. I am proud that I was one of the facilitators facilitating session on young women and safe abortion . Most of them were adult women whereas only few FCHVs were below 30 years. The training took place in Sugarkhal Health Post. During the training Health Post In-charge shared that it was really difficult task to recruit FCHVs when Nepal Government launched the program. He said 10-15 years back he and his team visited door to door asking each family to let their daughters, wives and sister-in-laws to become FCHVs. His team even begged people and each time they were refused. The reason behind it was conservative society which used to think women going around and talking about family planning are characterless. In-charge now feels proud that his VDC has more than 50 FCHVs actively working and government has appreciated importance of FCHVs. Now there are many families who wants their women members to be FCHVs and serve community.
FCHVs in Nepal are contributing factors to achieve its health related Millennium Goals. During my stay with FCHVs I got to know that they are also responsible to aware women about safe abortion services in the nearest health post. They monthly arrange meeting with mother’s groups and discuss about Medical Abortion service in Sugarkhal Health Post and they have been referring abortion cases to health posts and hospital for safe abortion. Therefore FCHVs play a supportive role in linking the community with available PHC services and to contribute to play an important role related to family planning, maternal/neonatal health, child health and select infectious diseases at the community level.
There was a situation assessment performed in Kailali district by Ipas Nepal. According to the report it was known that most of the young people in the district get information on SRHR from FCHVs. The young people who were interviewed also mentioned that as FCHVs are close to their family as they belong to same VDCs so they fear lack of privacy and confidentiality while sharing their SRHR problems to FCHVs. In conversation with FCHVs during the training, it was observed they are youth friendly and young people do approach them for contraceptives and other SRHR information.
On asking FCHVs whether they feel comfortable on providing family planning devices like condom, pills, etc to unmarried young women and men, few FCHVs hesitated saying sexual relation before marriage in their community is unexpected. Whereas all of them strongly agreed young people getting access to SRHR information and services. Regarding safe abortion services accessible to unmarried young women FCHVs preferred to encourage young women to use contraceptives and prevent them from abortion.
One of the FCHVs shared young unmarried women sometime participate in their monthly meeting with mother’s group. They do not interact but listen whatever discussed in meeting regarding contraceptive, child health, pregnancy test etc. She also added that adolescent is the period where young people like to experience new things, unknowingly later they get into trouble. Same thing happen to a young girl who got pregnant and used Oral contraceptive to abort her pregnancy. She had to rush to health post before severe complication. Later it was known that she once had participated in one of the Mother’s group meeting where she got to know about oral contraceptives. This means Little Knowledge is really Dangerous.
Most of all FCHVs committed to work for young people on disseminating information on SRHR and safe abortion to young people in their community to minimize unsafe abortion.
Even if FCHVs are popularly known as pillar of community health, there are challenges for them. There are demand of FCHVs to increase in conveyance allowance and additional pay and perks for FCHVs in remote villages, free health facilities for retired FCHVs and equal budget in all 75 districts for FCHV programs. As it is important to further promote this community volunteer scheme as it is one of the most successful programs in the health system of Nepal. Strengthening it would ensure that the FCHVs will be able to support the health staff at peripheral level to provide good quality health care.