Piloting Innovations in Nepal’s Community Health Worker Program

Abstract

Since its inception in 1988, Nepal’s Female Community Health Volunteer program had helped connect people in difficult-to-reach areas to the health system, but by the 2000s the Nepali government wanted to accomplish more. Many health outcomes were still poor, including high neonatal and infant mortality, and preventable infant- and child-specific diseases were among the top 10 leading causes of death in the country. In 2008, a Nepal-based non-governmental organization called Nyaya Health Nepal began working with the national health ministry to improve health services in one Nepali district. Development Challenge: The core development challenge that Nyaya’s pilot program aimed to address was strengthening the health system. There was low utilization of available health services and the morbidity and mortality rates in rural areas were high relative to urban areas. A related challenge was the variable quality of community health services across Nepal’s districts, which the government hoped to address in order to provide quality health care to all Nepalis. Project Solution: In 2008, Nyaya entered into the first public-private partnership with the Nepali health ministry. In 2010, Nyaya teamed up with the health ministry to pilot a project to strengthen the FCHV program in Achham, a district with some of the country’s worst health outcomes. The pilot implemented a new village-level leadership structure to increase oversight and support for volunteers and improve ties between individual community members and their local health centers. By 2014, Nyaya felt that the existing FCHV structure constrained the extent of healthcare improvements possible under the pilot. In 2014, Nyaya ended the FCHV support program in Achham and redirected staffing and resources to a cadre of professional community health workers under a new pilot program in the same district. Project Results: In analyzing program data over an 18-month period from 2014 to 2016, Nyaya saw good progress on several health outcome indicators within its area of operations. The institutional birthrate increased by 11.8 percentage points, completion of antenatal care increased by 6.4 percentage points, and rates of postpartum contraception increased by 27.5 percentage points. Infant mortality decreased from 18.3 per 1,000 to 12.5 per 1,000 live births.