Female Community Health Volunteer (FCHV) Program of Nepal: History, Role & Responsibilities, Progress, Data & Facts, Legal Aspects, and Additional Information

Introduction 

FCHVs are typically married women of reproductive age (15–49 years). They work in each ward, which is the smallest administrative division of a village/municipality. Their role is to improve PHC mainly maternal and child health through health education, referral, and treatment services. They have a crucial role in supporting people who are the least able to afford health care. FCHVs’ availability is a strength that differentiates them from other health-care professionals. They are familiar with the local context, including language. They also have the ability to recognize health problems and refer people in a timely fashion. 

Nepal’s Female Community Health Volunteer (FCHV) program started in 1988. It has become an integral part of the country’s community-based health system. National Female Community Health Volunteers (FCHV) Day is celebrated across Nepal on December 5th. This day honors the invaluable contributions of over 52,000 FCHVs. They serve as a vital link between communities and health facilities. Here’s a detailed overview of the program: 

History and Formation 

The FCHV program was launched in 1988 (FY 2045/46). It began in 27 districts. It gradually expanded to all 75 districts of Nepal.

Initially, the program selected one FCHV per ward, regardless of population size. In 1993/94, a population-based approach was introduced in 28 selected districts. FCHVs are chosen by Mothers’ Groups for Health (MG-H) members with assistance from local health facility staff.

Meaning of the FCHV logo:  
A small pebble thrown into a pond creates waves that spread across its surface. Similarly, the activities of FCHVs begin at the ward level and gradually expand to the VDC level. Ultimately, these actions will blanket the entire district and contribute to national development. The innermost circle shows the start of activities by individual FCHVs at the community level. This is central to health initiatives. The second circle illustrates the spread of these actions throughout the entire VDC. The third circle shows the coverage of the whole district by FCHVs. The outermost circle demonstrates their impact on the entire nation. 

Program Evolution and Support 

The FCHV program has evolved over the years to address changing community health needs. The government provides various benefits to FCHVs, including: 

The program evolved from earlier experiments with predominantly male community volunteers in the 1970s. It shifted to an all-female model in the late 1980s and early 1990s. This change was partly due to a focus on maternal and child health goals.

• 1988: Launch of the FCHV Programme in selected districts, primarily focusing on maternal and child health and family planning.
• 1990s: Expansion across districts, integrating health promotion and disease prevention initiatives such as immunization and nutrition programs.
• 2000s: FCHVs were mobilized for key national health campaigns, including Vitamin A supplementation, polio eradication efforts, and malaria prevention.
• Present Day: The FCHV Programme is integral to national health strategies, contributing to both Sustainable Development Goals (SDGs) and Nepal’s health indicators.

Objectives: 

1. To activate the women for tackling health problems by imparting relevant knowledge and skills
2. To prepare a pool of self-motivated volunteers as a focal person for bridging the health programs with community.
3. To prepare a pool of volunteers to provide services for community-based health programs
4. To increase the participation of community in improving health
5. To develop FCHV as a motivator of health
6. To increase utilization of health care services through demand creation

Training and Responsibilities 

FCHVs get 18 days of basic training, divided into two 9-day phases, covering primary healthcare components 

. Their responsibilities include: 

1. Distributing family planning commodities (pills and condoms)
2. Providing iron tablets to pregnant and lactating mothers
3. Distributing oral rehydration solutions
4. Offering health education and community outreach
5. Linking communities with health facilities and providing referral services
6. Supporting maternal and newborn health initiatives
7. Promoting immunization programs

Achievements and Impact 

Since its start, the FCHV program has made significant contributions to Nepal’s healthcare system: 

• Reduced mortality rates and improved maternal health
• Extended coverage of primary health care programs
• Distributed over 818,000 packets of ORS for managing diarrhea in children under
• Achieved 90% vitamin A and 84% deworming coverage

FCHVs gained legitimacy as health workers through participation in donor-funded vertical campaigns, like the integration of oral polio vaccine campaigns with the National Vitamin A Program in 19974 

Policies, Guidelines, and Strategies 

1. The FCHV program strategy was revised in 2010 (2067 BS), providing strategic directions and approaches to strengthen the national program.
2. In fiscal year 2064/65 (2007/08), the government established an FCHV fund, providing Rs. 50,000 to each Village Development Committee for income-generating activities.
3. The current FCHV guideline stipulates that volunteers must be married and reside in the ward they serve.
4. Various benefits are provided to FCHVs, including:

• An FCHV fund for income-generating activities
• Dress allowances and identity cards
• Free healthcare services
• Recognition through national and international learning visits

Challenges and Future Directions 

Despite their success, FCHVs face several challenges: 

1. Increasing workload and opportunity costs due to male out migration from villages.
2. Dissatisfaction with pay, led to labor movements starting in the 2010.
3. Questions about the relevance of FCHVs in a modernizing health system.
4. Navigating social barriers while delivering health services, particularly for non-communicable diseases.

As the program continues to evolve, we need to explore strategies for sustaining and expanding the FCHV program. These strategies should address emerging health issues. They must also ensure fair compensation for these vital community health workers.

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Guidelines and Legal Documents