Female Community Health Volunteers (FCHVs) play a key role in providing family planning services in remote areas of Nepal. A survey of over 4,000 FCHVs found that they provide counseling on family planning and distribute condoms and pills. Many FCHVs also refer clients for other family planning services. Stakeholders perceive FCHVs as important for overcoming cultural barriers and improving access to family planning. The study concludes that continuing and adapting the FCHV program, with a focus on high-impact activities like family planning, maternal and child health, and nutrition, can help meet Nepal's changing health needs. Regular training and commodity supplies are also needed to support FCHVs' work.

1. THE ROLE OF FEMALE COMMUNITY
HEALTH VOLUNTEERS IN
PROVIDING KEY FAMILY PLANNING
SERVICES TO WOMEN IN HARD TO
REACH AREAS ACROSS NEPAL
International Conference on Family Planning
Bali, Indonesia – January 25-28, 2016
Presenter: Savitha Subramanian
Co Authors: Sophia Magalona, Leela Khanal, and Binjwala
Shrestha

2. NEPAL CONTEXT
• Total Fertility Rate among women aged 15-49 years is
2.6
• Almost one quarter of women give birth by the age of 18;
nearly half by 20
• Knowledge of contraception is universal
• Contraceptive Prevalence Rate is 49.7%
Source: DHS 2011

3. FCHVs IN NEPAL
• The Female Community Health Volunteer (FCHV)
program was initiated in 1988.
• The FCHV program focuses on family planning,
maternal/neonatal and child health.
• More than 52,000 FCHVs are active across Nepal.
• The FCHV program is widely acclaimed for its
contribution in reducing child mortality and improving
maternal health in the country

4. OBJECTIVES
• To conduct a comprehensive national survey across 13 domains focusing on:
• To understand how FCHVs perceive their work and factors influencing their
motivation for continuing to serve as FCHVs
• To understand how stakeholders and communities perceive the role of
FCHVs and identify strategies to ensure program sustainability
FCHV socio-
demographic
and work
profile
Support
received by
FCHVs
FCHV
services

5. METHODOLOGY
Quantitative Data Collection
• Systematic random sampling
with the ward/FCHV as the
primary sampling unit in each of
the 13 domains
• Sample selection stratified by
urban and rural wards to ensure
adequate representation
• Use of PC tablets for data
collection and storage
using SurveyCTO and Enketo
• Total of 4,302 FCHVs
interviewed
Qualitative Data Collection
• Purposive sampling to include
various levels of respondents 12
(rural and urban districts) within
8 of the 13 domains included in
the qualitative survey
• 48 Klls and 34 FGDs with 106
participants

6. ANALYSIS
Quantitative Survey
• Univariate and bivariate
analysis
• Results weighted based on
the relative size of the
districts in the13 domains
• Stratified by residence (urban
vs. rural), literacy, FCHV age,
and time it takes FCHV to
reach health facility
• Chi-square tests
Qualitative Information
• Transcribed and analyzed per
protocol
• Thematic coding analysis

7. RESULTS

8. FCHV PROFILE
• Average age 41.3 years
• 67% of FCHVs reported attending school; of these 45%
attended 6th-12th grade
• 83% of FCHVs were literate
• 90% of FCHVs were married
• 59% of FCHVs served > 10 years
• 96% of FCHVs reported receiving basic training

9. FP COUNSELING

10. FP COUNSELING

11. DISTRIBUTION OF FP COMMODITIES
0
10
20
30
40
50
60
70
80
90
100
PercentofFCHVs
Domain
Condoms (%) Ever distributed condoms in the
3 months prior to survey (n=2664)
Pills (%) Ever distributed pills in the 3 months
prior to survey (n=2661)

12. REFERRALS FOR FP SERVICES
45
32
49
34
27
41
27
23
50
28
45
33
59
0
10
20
30
40
50
60
70
80
90
100
PercentageofFCHVs
DOMAIN
Percent of FCHVs who recorded referringcouples for family planning
services in the three months prior to survey (n=2662)

13. REFERRALS FOR FP SERVICES
0
10
20
30
40
50
60
70
80
90
100
PercentageofFCHVs
DOMAIN
Percent of FCHVs Reporting Providing Referralsfor Sterilization in
the Year Prior to the Survey (n=4302)
Women referred for sterilization
in the year prior to survey
Men referred for sterilization in
the year prior to survey

14. PERCEPTIONS ON FCHVs ROLE IN PROVIDING
HEALTH AND FP SERVICES
“FCHVs are the eyes and ears of the
health programs, because they are
working as the main media of the
community problem. They bring all the
health problems to health facility. With
her information we are organizing the
community health program.” –KII, AHW
“We can discuss with FCHVs openly, we
don't feel shame to discuss family
planning, pregnancy. We don't feel easy to
outsider in this matter. We are satisfied
with FCHV's service.” –FGD, Community
Beneficiaries

15. PERCEPTIONS ON FCHVs ROLE IN PROVIDING
HEALTH AND FP SERVICES
“FCHV are playing important role to
break cultural barrier, because in
remote community women are illiterate
and feel shame to visit health facility,
especially family planning, ANC and
delivery care.”-KII, ANM
“Now with help of FCHV child death are
prevented. Number of pregnancy also
limited due to promotion of family
planning”-FGD, Community Beneficiaries
(Remote VDC)

16. POLICY IMPLICATIONS
• The FCHV program needs to be continued and
adapted to meet changing and varying needs
• Specific (contextualized) FCHV services vs.
blanket approach
• Targeting resources to specific high-impact
activities by FCHVs (MNCH, FP and Nutrition)
• Ensuring regular commodities availability to help
increase performance of the FCHV’s
• Supportive supervision and monitoring
mechanism for FCHVs
• Additional FCHV training or refresher training
• Better record keeping and use of registers is
likely to improve service outcomes

17. ACKNOWLEDGEMENTS
Funding
USAID
UNICEF
Save the Children
Study Implementation Team
JSI R&T
HERD
FHI360
Key Advisors/Stakeholders
Department of Health Services,
Nepal
Family Health Division, MOH
NHRC
Respondents
FCHVs
Key informants - central-level,
district-level, health workers,
health facility management
committee members, and
community beneficiaries