The female community health volunteers: unsung heroes

In the 1980s, Nepal commenced a programme of female community health volunteers (FCHVs), commonly known as “Mahila swoyemsewika”, which means “female volunteer”. Their roles were to support family planning in the early days, especially by distributing birth control pills and condoms. Gradually, their roles were extended to include other programmes.¹ The volunteers are influential in achieving the health-related Millennium Development Goals and other targets.² This programme has been the backbone of the health system in Nepal for the past three decades.

Nepal's health system has evolved over the centuries, starting with Ayurvedic medicine and progressing to modern allopathic treatment. Several improvements and changes in the health system have been made over time. Furthermore, the health system is strengthened by people's participation and better management of health information and drug supply.³

The role of FCHVs in the promotion of health in Nepal is unexplainable. They are directly involved in health promotion activities like sanitation, nutrition, family planning, human immunodeficiency virus (HIV), maternal and child health care. They keep detailed information about every member of the community, which assists in collecting and reporting demographic data. Their role in polio campaigns, deworming, integrated management of childhood illness and vaccination is immense.

FCHVs are the first responders in emergencies and disasters in Nepal. In rural Nepal, there is competition between local or ritual healing practices and biomedical services. By assisting villagers in negotiating, FCHVs help to settle this medical pluralism. They've also taught faith healers how to refer patients to medical facilities.

“Everyone is talking about the role of consultant psychiatrists in developing mental health plans and neurotropic drugs,” the Director-General of Nepal said during a mental health program titled “World Health Organization (WHO) special initiative for mental health Nepal.” “Have we forgotten about the female community health volunteers? They are the ones who identify people with mental illnesses first, and they are the backbone and pillars of the program that we are planning.” As aforementioned, they have a direct role in identifying mental disorders, chronic diseases like hypertension and diabetes mellitus by mass screening, people with disabilities and many more.

Every spring season, the Terai belt of Nepal suffers a huge loss of manpower, capital and harvest due to massive floods. The FCHVs are the ones who prevent the sufferers from developing post-traumatic stress disorders. They counsel them, administer first-aid and prevent them from drowning in a sea of sorrow and grief. Other disasters, like earthquakes, do not stop them from dedicating their lives to the welfare of others. To a matter of surprise, they do not get paid regular salaries. If not them, who is the backbone of the health system in Nepal?

Sarita Thapa is a “female community health volunteer” – instantly recognizable in Nepal with her bright double-blue sari. She’s one of more than 50,000 women across the country connecting her community to the health system. They’ve been called the backbone of the health system, the “florence nightingales of Nepal.”⁴

“I wanted to be a nurse,” Sarita, 30, explains. “But I started a family early and put my further education on hold. I still wanted to serve the children of my community.”

Society and institutions in Nepal are traditional, conservative, and patriarchal, with women’s roles limited to childbearing, household maintenance, and income-earning.⁵ Despite the paradoxical social structures, norms, and values, these volunteers have established their status as respected members of the community. They work day and night continuously to upgrade the health condition of Nepal.

Pelvic organ prolapse is a common problem in women of rural communities. In a mega health camp, a woman was found to be living with it for 15 years. The stigma is still prevailing. And, it is one of those female volunteers who identified the problem and brought the victim to the service centre.

To no matter of surprise, they also run awareness campaigns in schools and villages. They demonstrate the dangers of smoking and drinking by raising awareness and assisting people in quitting their bad habits. WHO South-East Asia region has a goal of eliminating measles by 2023. The role of FCHV in this is unquestionable. They play an important part in the national and global health system, from polio eradication, measles elimination, nutrition programs to disaster management. They serve in every region of Nepal. From the snow-capped villages in the Himalayas to tribal regions, their effort is unique and inevitable. So, who are they, and what do we know about them? They are Nepal's "unsung heroes," who have helped to improve the country's health from its nadir.

REFERENCES

1. 1. Khatri RB, Mishra SR, Khanal V. Female community health volunteers in community-based health programs of Nepal: future perspective. Front Public Health. 2017;5:181.
2. 2. Panday S, Bissell P, Van Teijlingen E, Simkhada P. The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study. BMC Health Serv Res. 2017;17:623.
3. 3. Marasini B. Health System Development in Nepal. JNMA J Nepal Med Assoc. 2020;58(221):65-8.
4. 4. Kandel N, Lamichhane J. Female health volunteers of Nepal: the backbone of health care. Lancet. 2019;393(10171):19-20.
5. 5. Radl CM, Rajwar R, Aro AR. Uterine prolapse prevention in Eastern Nepal: the perspectives of women and health care professionals. Int J Womens Health. 2012;4:373-82.