Abstract
BackgroundIn 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.MethodsBetween 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.ResultsAll 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.ConclusionsOur 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.
Highlights
In resource-poor settings, the provision of basic maternity care within health centres is often a challenge
Public healthcare services were relatively accessible in Terai, taking approximately 30 min to reach on foot, compared with the hill region where the walking distance to the nearest health centre ranged from 40 min to an hour and in one case up to six hours
The evidence from this study demonstrates that Female Community Health Volunteer (FCHV), supported by the government healthcare system, play an important role in the provision of basic maternal healthcare in resource-poor settings in Nepal
Summary
In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. 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. CHWs have become a central feature of many Primary Health Care (PHC) programmes in resourcepoor areas of low-income countries They are viewed as important contributors to achieving the Millennium Development Goals (MDGs) for maternal and child health [1, 2, 4]. FCHVs are the lowest level or ‘first contact’ PHC providers within the public healthcare system
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