Equity and Empowerment_R. Shrestha_10.17.13
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Transcript of Equity and Empowerment_R. Shrestha_10.17.13
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25 years of Nepal’s FCHV Program: Lesson Learned
Dr. Ram Kumar ShresthaCommunity health and Nutrition
Senior Quality Improvement AdvisorASSIST Project/URC
Ram Kumar Shrestha, Nepal
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Mothers Group
Districts Health Office
H P
Health Post /Sub-Health Post
PHC
National FCHV Program, Family Health Division
VHW/MCHW
FCHV focal person
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Problems with FCHV program before implementation of NVAP (1993)
• FCHV were not selected properly • Not all FCHVs received basic training • FCHV did not receive regular Refresher Training• HF did not consider FCHV as a part of their system• FCHV Supervision from HF was weak • FCHV did not receive financial support• FCHVs were not motivated• Continued addition of New tasks • Expected to visit all HHs
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Surkhet
Bardiya
Dadeldhura
Dang
Kapilvastu
Kailali
Kanchanpur
Achham
Darchula
Bajura
Bajhang
Humla
DolpaKalikot
Jumla
Mugu
Sarla
hi
MorangSunsari
Jhapa
Tanahun
Manang
Mustang
ChitawanMakawanpur
RolpaSalyan
Rukum
Jajarkot
Dhad
ing
Gorkha
Nuwakot
RasuwaPyuthan
Udayapur
Okhaldhunga
Sankhuwasabha
SolukhumbuTaplejung
Palpa
Myagdi
Syangja
KaskiLamjung
Arghakhanchi
Gulmi
Baglung
Parb
at
Dailekh
Banke
Rupandehi
Doti
Baitadi
Nawalparasi
Parsa
Mah
ottar
i
Dha
nush
a
Siraha
Raut
ahat
Bara
Saptari
Sindhuli
Sindhupalchok
Kavrepalanchok
Ramechhap
Dolakha
Dhan
kuta
Khotang Bhojpur
Ilam
Terh
athu
m
PanchtharLegend:Legend:
PHASE I (October 1993)
PHASE II (April 1994)
PHASE III (October 1994) PHASE IV (April 1995)
PHASE V (October 1995)
PHASE VI (April 1996) PHASE VII (September 1996)
PHASE VIII (October 1997)
PHASE IX (April 1998)
PHASE X (October 1998) PHASE XI (April 1999)
PHASE XII (October 1999)
PHASE XIII (April 2000)
PHASE XIV (October 2000) PHASE XV (April 2001)
PHASE XVI (October 2001)
PHASE XVII (October 2002)
National Vitamin A Program, Nepal (1993 – 2002)Program spread to all districts by Phase
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CHW
Approach – Community Health Worker
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Current Situation of Community Health Workers
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SUPPORT TO FCHV
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FCHV Planning with multi-sectoral staff
• FCHVs play the leading role for message dissemination
• Interactive miking, magic shows, parades and theater performances and town criers are used
• Schools, police, local business groups, women’s groups, community leaders are mobilized
• Broadcast of vitamin A messages on radio and TV complements these promotion activities
Ram Kumar Shrestha, Nepal
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MotivationMotivation is defined as the driving force behind our desire for something. It could either results from our desire for something that is internally driven (Intrinsic) or it could result from our desire for something outside (External Driven) of us.
TRUST
Motivation is Not Static but it is Dynamic in nature
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Factors sustaining motivation of FCHV for more than 20 years
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Hand-over of EF passbook to FCHVHand-over of EF passbook to FCHV
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"Finally we have received some support for our hard work""Finally we have received some support for our hard work"
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Achievements of FCHV program
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91 89 89 90 91 9095 96 97 97 95 97 98
0102030405060708090
100
1 2 3 4 5 6 7 8 9 10 11 12 13
Number of Program Years
% o
f C
over
age
National Vitamin A ProgramAverage Capsule Coverage by the Number of the Years in Program (2007)Average Capsule Coverage by the Number of the Years in Program (2007)
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0
10
20
30
40
50
60
70
1996 1997 1998 1999 2000 2001 2002 2003
Programme Districts Non-programme Districts
Community Based Treatment of Pneumonia
Proportion of Expected Pneumonia Cases Treated (%)
8,500 deaths averted each year8,500 deaths averted each year
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Trend in Under-Five Mortality1986-2016
201
155
120
4356
7291
0
50
100
150
200
1981-86
1986-91
1991-96
1996-01
2001-06
2006-11
2011-16
De
ath
s p
er
10
00
liv
e b
irth
s Estimates
Based on DHS 1996
Based on DHS 2001
MDG = 54 deaths per 1000 live births by 2015
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17
^Approximate numbers for illustrative purposes only
Coverage with ANC anemia interventions, Nepal DHS, 2001-2011
Indicator ZoneYear of Survey
2001 2006 2011
% attending ANC
Mtn/Hill 38^ 64^ 79^Terai 56 81 90National 49 75^ 85
% receiving any iron
Mtn/Hill 19^ 51^ 75^Terai 25 66 84National 23 61^ 80
% receiving dewormer
Mtn/Hill 15^ 52^Terai 25 58National 22^ 55
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Next Steps
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Schools
Religious Community
Women’s
Group
Local Health Clinic
$Savings & Credit Group
Local Government
Community Health System
Community Committee
Ram Shrestha
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Schools
Religious Community
Women’s
Group
Local Health Clinic
$Savings & Credit Group
Local Government
CHW
Community Health System
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