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Early pregnancy detection by female community health volunteers in Nepal facilitated referral for appropriate reproductive health services

Abstract / Summary: 
ABSTRACT: Background: Female community health volunteers (FCHVs) are a possible entry point for Nepali women to access timely reproductive health services at the village level. This evaluation assessed the success of a pilot program that trained FCHVs in early pregnancy detection using urine pregnancy tests (UPTs), counseling, and referral to appropriate antenatal, safe abortion, or family planning services.    Methods: Between July 2008 and June 2009, the program trained 1,683 FCHVs from 6 districts in provision of UPTs and appropriate counseling and referral; 1,492 FCHVs (89%) provided follow-up data. Trained FCHVs provided data on the number of clients served and the type of services provided. In addition, the program conducted in-depth interviews with selected FCHVs and other reproductive health service providers on their perceptions of the program.   Results: Of the FCHVs with follow-up data, 80% reported providing UPTs to women in the eight-month follow-up period. In total, they conducted 4,598 UPTs, with a mean number of 3.1 tests per FCHV. Among the women with a negative pregnancy test (47%), FCHVs provided 24% of them with oral contraceptive pills and 20% with condoms; they referred 10% for other contraceptive services, and provided contraceptive counseling only to 46%. Among the women with positive pregnancy tests (53%), FCHVs referred 68% for antenatal care and 32% for safe abortion services.   Conclusions: Providing FCHVs with the skills and supplies required for early pregnancy detection allowed them to make referrals for appropriate reproductive health services. Results of this evaluation suggest that community health workers such as FCHVs are a promising channel for early pregnancy detection and referral. As the intervention is scaled up, the focus should be on ensuring service availability and awareness of available services, UPT supply, and creating viable options for record keeping.
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Timely identification of pregnancy is important to initiate antenatal care (ANC) among women with wanted pregnancies and to seek abortion services among women with unwanted pregnancies. [...] Lack of certainty about pregnancy status can cause delays in seeking ANC or abortion.

[... Nepal's Ministry of Health and Population in 1988, uses community-based volunteers, known as female community health volunteers (FCHVs), to reach women in remote areas and link them with available services. This network, currently comprising more than 48,000 local female volunteers, is a trusted source of maternal and child health information and serves as the key referral link between communities and health services.

FCHVs are selected by the Mothers' Group at the village development committee (VDC) level, and each ward within the VDC typically has one FCHV. Criteria for selection include membership in the VDC, literacy, and age between 25 and 45 years, but the actual characteristics of FCHVs vary. A study found that the median age for FCHVs was 38 years and that 4% of FCHVs were over age 60.11 The study also found that only 62% of FCHVs were literate, but FCHVs were better educated than the general population of rural women of the same age.11 Literacy levels did not affect the quality of services provided by FCHVs.

Once selected, FCHVs attend an 18-day training on basic maternal and child health information; training on additional topics is conducted as needed. Services provided by FCHVs once they return to their communities include:

- Holding monthly meetings on health issues with the Mothers' Group in their villages

- Visiting households to advise on maternal and newborn care and immunizations and to distribute condoms and oral contraceptive pills to existing users

- Iron/folate distribution

- Postpartum vitamin A distribution

- Treatment of children with diarrhea using oral rehydration solution

- First aid

- Community-based pneumonia treatment in some districts

FCHVs are not permitted by law to provide injections or any medical procedure. FCHVs do not receive compensation for their work, but they do get reimbursed for travel expenses when attending trainings and receive money to purchase tea and snacks for their monthly Mothers' Group meetings.

FCHVs work, on average, 5.1 hours each week, and annual turnover is low (4%).


Formal literature type: 

Andersen, Kathryn et al.

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