“It’s hard to pinpoint one reason [why]. Part of it could be the contributions of the female community-health volunteers, part of it is more trust in health facilities,” said Isha Nirola, the community-health director at Possible, a nonprofit which works with Nepal’s Ministry of Health to bolster its services. “It’s been very successful in the mass distribution of medicines.”
That proximity to their patients is a great strength of these women who live in the communities they serve. In a recent study, after Nepali mothers gave birth, more than half of such volunteers arrived within 30 minutes—and three-quarters within 60 minutes.
The study looked at residents of Dhanusha, a district in the plains of central Nepal where 89 percent of the population lives in rural areas, and approximately 67 percent of women deliver their babies at home. The volunteers identified low-birth-weight infants with spring scales 80 percent of the time. Mothers had 40 percent accuracy. Low birth weight is a major risk factor in neonatal death, and armed with this early assessment, the volunteers and families could take action.
When the devastating 7.8 earthquake hit Nepal in April, many volunteers were victims themselves, said Stuti Basnyet, a senior development and communications specialist at USAID/Nepal. Ten were killed in the 12 most-affected districts. “In the immediate aftermath of the quake, they were in no position to help others on any great scale,” she wrote in an email.
“Three months on, while the struggle to rebuild lives and livelihoods continues…most have resumed their work.” She added that female community-health volunteers “continue to remain the backbone of many of Nepal’s public-health programs.”
Other countries have launched similar programs, but Nepal has “one of the biggest, longest running successful programs in the world,” said Claire Glenton, senior scientist at the Norwegian Knowledge Centre for the Health Services.
In Glenton’s study of female community-health volunteers, a new mother shared her story with researchers: After giving birth, she hemorrhaged and her baby died. A female community-health volunteer stopped her bleeding. “Inside me I thought, ‘It’s because of unawareness mothers are dying. It’s because of unawareness our kids are dying … I need to work for this community.’ So with this thought, I became an FCHV.”
Less than five percent of female community-health volunteers drop out of the program each year, the study found. The volunteers report being motivated by their enhanced social standing, religious, and moral duty.
“Whenever someone is ill in our community, they come looking for us first,” a volunteer reported in the study. “It’s a matter of pride for us to be taking care of our neighbors and community members.”
A recent study found that volunteers seem to raise the self-confidence of mothers, which could help prevent child injuries. Three focus groups were conducted between September 2013 and May 2014, in rural Makwanpur district in central Nepal, where many residents are subsistence farmers and survive on remittances from family working abroad. Participants reported that they felt able to speak in public on behalf of their children for the first time during discussions they had with the community-health volunteers, which in turn empowered them to identify risks and hazards and implement community-wide actions such as filling up ditches and putting fences around the roof and balconies on houses.