[PHP Nepal Vol 1 Issue 7 Jul 2011] | Not everything in this country in transition is to be cursed at or looked down upon. Setting aside the political imbroglio, economic constraints, power-shortage and all; there's indeed a matter that brings a rarely available pride for us and shows a glimmer of hope in the field of health. The achievements in terms of lowering children and maternal mortality ratios which are also the targets of millennium development goals (MDGs)-4 and 5 respectively are really worthy of salute. Maternal mortality ratio (MMR) that was 539 per one hundred thousand live-births in 1996 (Nepal Family Health Survey/NFHS) has been brought to 281 by 2006 (Nepal Demographic Health Survey/NDHS conducted quinquennially).
There are even more encouraging reports based on research that the figure has indeed climbed down to 229. The official target as per MDG is 134 which appear tough to attain but possible. Similarly, Child Mortality Rate (more precisely called Under five mortality rate) which stood at staggering 91 per one-thousand live-births in 1996 (NFHS) has been reduced to 61 as of NDHS 2006 report.
The aforementioned achievements were not accomplished out of a miracle. A determined and altruistic group called Female Community Health Volunteers (FCHVs) whose number hovers around a whopping 50,000 is the key to these successes. FCHVs concept was institutionalized in 1988 in 27 districts and expanded to all 75 districts in a phased manner. Now that concept has taken a new shape in a more constructive way in the sense that they are the active participants in almost every national health programmes-be it vitamin A distribution, immunization, deworming through albendazole tablets, safe motherhood services or even more focused ones like Community Based Integrated Management of Childhood Illness (CB-IMCI) and Community Based Newborn care Program (CB-NCP). CB-IMCI is a program mainly related to save the child deaths from 2 months to 5 years from major killer diseases and illnesses viz. measles, malaria, malnutrition, pneumonia and diarrhea. Whereas, CB-NCP is a program with two main objectives i.e. to encourage the health facility based delivery and to prevent death of infants from infections in home deliveries.
Just like the whole nation, as it seems, is laden with a spectrum of problems, FCHVs are no exception. It can be grasped by the fact that more and more programmes are pouring in and their busyness has hastened proportionately. Moreover, a many are illiterate that makes it difficult for them to fill out different forms and formats (for example, CBNCP forms) for reporting and training and materials need to be adapted to their literacy level.
A female with a blue bag consisting iron, vitamin-A and zinc tabs, bag and mask (to revive asphyxiated babies), timer (to count the chest in drawing inwards), albendazole and other belongings will appear at your doorstep if you seek for one. She is not a doctor. She is a Nepali daktar.
Rajan Sharma is a District Public Health Coordinator in Dhulikhel, Nepal.