COUNTRY PROFILE: NEPAL NEPAL COMMUNITY HEALTH PROGRAMS

FEBRUARY 2014

Advancing Partners & Communities

Advancing Partners & Communities (APC) is a five-year cooperative agreement funded by the

U.S. Agency for International Development under Agreement No. AID-OAA-A-12-00047, beginning

October 1, 2012. APC is implemented by JSI Research & Training Institute in collaboration with FHI 360.

The project focuses on advancing and supporting community programs that seek to improve the overall

health of communities and achieve other health-related impacts, especially in relationship to family

planning. APC provides global leadership for community-based programming, executes and manages

small- and medium-sized sub-awards, supports procurement reform by preparing awards for execution

by USAID, and builds technical capacity of organizations to implement effective programs.

Recommended Citation

Advancing Partners & Communities. 2014. Country Profile: Nepal Community Health Programs. Arlington,

VA: Advancing Partners & Communities.

Photo Credit: Aisha Faquir/World Bank

JSI RESEARCH & TRAINING INSTITUTE, INC. 1616 Fort Myer Drive, 16th Floor

Arlington, VA 22209 USA

Phone: 703-528-7474

Fax: 703-528-7480

Email: info@advancingpartners.org

Web: advancingpartners.org

This publication was produced by Advancing Partners & Communities (APC), a five-year cooperative agreement

funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-12-00047, beginning

October 1, 2012. The authors' views expressed in this publication do not necessarily reflect the views of the U.S.

Agency for International Development or the United States Government.

COUNTRY PROFILE*

NEPAL COMMUNITY HEALTH PROGRAMS

FEBRUARY 2014

* Adapted from the Health Care Improvement Project’s Assessment and Improvement Matrix for community health worker programs, and PATH’s

Country Assessments of Community-based Distribution programs.

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NEPAL COMMUNITY HEALTH PROGRAMS

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NEPAL COMMUNITY HEALTH PROGRAMS

TABLE OF CONTENTS

ACRONYMS..................................................................................................................... VI

I. INTRODUCTION .......................................................................................................... 1

II. GENERAL INFORMATION ........................................................................................ 1

III. COMMUNITY HEALTH WORKERS ........................................................................ 5

IV. MANAGEMENT AND ORGANIZATION .............................................................. 12

V. POLICIES ..................................................................................................................... 16

VI. INFORMATION SOURCES ..................................................................................... 18

VII. AT-A-GLANCE GUIDE TO NEPAL COMMUNITY

HEALTH SERVICE PROVISION ................................................................................... 19

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NEPAL COMMUNITY HEALTH PROGRAMS

ACRONYMS

AIDS acquired immunodeficiency syndrome

ARI acute respiratory infection

BCG Bacille Calmette-Guerin (vaccine for tuberculosis)

CB-IMCI Community Based Integrated Management of Childhood Illness Program

CB-NCP Community Based Neonatal Care Program

CHW community health worker

DD diarrheal disease

DPHO District Public Health Office

DPT diphtheria, pertussis, tetanus vaccine

EPI Expanded Program of Immunization

FAM fertility awareness methods

FCHV female community health volunteers/Female Community Health Volunteers Program

FP family planning

HFOMC Health Facility Operations Management Committee

HIV human immunodeficiency virus

HMIS health management information system

INGO international nongovernmental organization

IUD intrauterine device

JE Japanese encephalitis

MCHW maternal child health workers

MGH Mothers Group for Health

MOHP Ministry of Health and Population

NCBHP National Community-Based Health Programs

NGO nongovernmental organization

ORS oral rehydration solution

PPH postpartum hemorrhage

RHD Regional Health Directorate

SDM Standard Days Method

VDC village development committees

VHW village health workers

VSC voluntary surgical contraception

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NEPAL COMMUNITY HEALTH PROGRAMS

I. INTRODUCTION

This Country Profile is the outcome of a landscape assessment conducted by Advancing Partners & Communities (APC) staff and colleagues.

The landscape assessment focused on the United States Agency for International Development (USAID) Population and Reproductive

Health priority countries, and includes specific attention to family planning as that is the core focus of the APC project. The purpose of the

landscape assessment was to collect the most up to date information available on the community health system, community health workers,

and community health services in each country. This profile is intended to reflect the information collected. Where possible, the information

presented is supported by national policies and other relevant documents; however, much of the information is the result of institutional

knowledge and personal interviews due to the relative lack of publicly available information on national community health systems. As a

result, gaps and inconsistencies may exist in this profile. If you have information to contribute, please submit comments to

info@advancingpartners.org. APC intends to update these profiles regularly, and welcomes input from our colleagues.

II. GENERAL INFORMATION

1 What is the name of this program*,

and who supervises it (Government,

nongovernmental organizations

(NGOs), combination, etc.)?

Please list all that you are aware of.

*If there are multiple programs, please

add additional columns to the right to

answer the following questions according

to each community health program.

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NEPAL COMMUNITY HEALTH PROGRAMS

2 How long has this program been in

operation? What is its current status

(pilot, scaling up, nationalized,

non-operational)?

3 Where does this program operate?

Please note whether these areas are

urban, peri-urban, rural, or pastoral. Is

there a focus on any particular region

or setting?

Please note specific districts/regions,

if known.

4 If there are plans to scale up the

community health program, please

note the scope of the scale-up (more

districts, regional, national, etc.) as well

as location(s) of the planned future

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2

1

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NEPAL COMMUNITY HEALTH PROGRAMS

implementation sites. 3

4

5 Please list the health services delivered

by community health workers

(CHWs5) under this program. Are

these services part of a defined

package? Do these services vary by

region?

2

3

4

5

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NEPAL COMMUNITY HEALTH PROGRAMS

6 Are FP services included in the defined

package, if one exists?

7 Please list the FP services and methods

delivered by CHWs.

8 What is the general service delivery

system (e.g. how are services provided?

Door-to-door, via health posts/other

facilities, combination)?

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NEPAL COMMUNITY HEALTH PROGRAMS

III. COMMUNITY HEALTH WORKERS

9 Are there multiple cadre(s) of health

workers providing services at the

community level? If so, please list them

by name and note hierarchy.

10 Do tasks/responsibilities vary among

CHWs? How so (by cadre,

experience, age, etc.)?

11 Total number of CHWs in program?

Please break this down by cadre, if

known, and provide goal and estimated

actual numbers. Please note how many

are active/inactive, if known.

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NEPAL COMMUNITY HEALTH PROGRAMS

12 Criteria for CHWs (e.g. age, gender,

education level, etc.)?

Please break this down by cadre, if

known.

13 How are the CHWs trained? Please

note the length, frequency, and

requirements of training.

Please break this down by cadre, if

known.

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NEPAL COMMUNITY HEALTH PROGRAMS

14 Do the CHWs receive comprehensive

training for all of their responsibilities

at once, or is training conducted over

time? How does this impact their

ability to deliver services?

15 Please note the health services

provided by the various cadre(s) of

CHW, as applicable (i.e. who can

provide what service).

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NEPAL COMMUNITY HEALTH PROGRAMS

17 Do CHWs distribute commodities in

their communities (i.e. zinc tablets, FP

methods, etc.)? Which

programs/products?

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NEPAL COMMUNITY HEALTH PROGRAMS

18 Are CHWs paid, are incentives

provided, or are they volunteers?

Please differentiate by cadre, as

applicable.

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NEPAL COMMUNITY HEALTH PROGRAMS

19 Who is responsible for these

incentives (MOHP, NGO, municipality,

combination)?

20 Do CHWs work in urban and/or rural

areas?

21 Are CHWs residents of the

communities they serve? Were they

residents before becoming CHWs

(i.e. are they required to be a member

of the community they serve)?

22 Describe the geographic

coverage/catchment area for each

CHW.

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NEPAL COMMUNITY HEALTH PROGRAMS

23 How do CHWs get to their clients

(walk, bike, public transport, etc.)?

24 Describe the CHW role in data

collection and monitoring.

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NEPAL COMMUNITY HEALTH PROGRAMS

IV. MANAGEMENT AND ORGANIZATION

25 Does the community health program

have a decentralized management

system? If so, what are the levels (state

government, local government, etc.)?

26 Is the MOHP responsible for the

program, overall?

27 What level of responsibility do

regional, state, or local governments

have for the program, if any?

Please note responsibility by level of

municipality.

28 What level of responsibility do

international and local NGOs have for

the program, if any?

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NEPAL COMMUNITY HEALTH PROGRAMS

29 Are CHWs linked to the health

system? Please describe the

mechanism.

30 Who supervises CHWs? What is the

supervision process? Does the

government share supervision with

INGO/NGOs? If so, please describe

how they share supervision

responsibilities.

31 Where do CHWs refer clients for the

next tier of services? Do lower-level

cadres refer to the next cadre up (of

CHW) at all?

32 Where do CHWs refer clients

specifically for FP services?

Please note by method.

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NEPAL COMMUNITY HEALTH PROGRAMS

33 Are CHWs linked to other community

outreach programs?

34 What mechanisms exist for knowledge

sharing among CHWs/supervisors?

35 What links exist to other institutions

(schools, churches, associations, etc.)?

36 Do vertical programs have separate

CHWs or "share/integrated"?

37 Do they have data collection/reporting

systems?

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NEPAL COMMUNITY HEALTH PROGRAMS

38 Describe any financing schemes that

may be in place for the program (e.g.

donor funding/MOH budget/municipal

budget/health center user fees/direct

user fees).

39 How and where do CHWs access the

supplies they provide to clients

(medicines, FP products, etc.)?

40 How and where do CHWs dispose of

medical waste generated through their

services (used needles, etc.)?

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NEPAL COMMUNITY HEALTH PROGRAMS

V. POLICIES

41 Is there a stand-alone community health

policy? If not, is one underway or under

discussion?

Please provide a link if available online.

Female Community Health Volunteers Strategy

42 Is the community health policy integrated

within overall health policy? Nepal Health Sector Program - Implementation Plan II (NHSP-IP2) 2010-2015,

National Nutrition Policy and Strategy 2004,

and the National Safe Motherhood and Newborn Health Long Term Plan 2006-2017

43 When was the last time the community

health policy was updated?

(months/years?)

44 What is the proposed geographic scope of the program, according to the policy?

(Nationwide? Select regions?)

45 Does the policy specify which services can

be provided by CHWs, and which cannot?

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NEPAL COMMUNITY HEALTH PROGRAMS

46 Are there any policies specific to FP

service provision (e.g. CHWs allowed to

inject contraceptives)?

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NEPAL COMMUNITY HEALTH PROGRAMS

VI. INFORMATION SOURCES

Gottlieb, Jessica. No date. Reducing Child Mortality with Vitamin A in Nepal. Available at http://www.cgdev.org/doc/millions/MS_case_4.pdf (accessed February 2014).

Government of Nepal, Child Health Division. 2007. Operational Guidelines for the Community Based Integrated Management of Childhood Illness (CH-IMCI) Program 2064 (July, 2007).

Kathmandu, Nepal: Government of Nepal.

Ministry of Health and Population, Child Health Division. 2004. National Nutrition Policy and Strategy. Kathmandu, Nepal: Ministry of Health and Population. Available at

http://mohp.gov.np/english/files/new_publications/9-1-Nutrition-Policy-and-strategy.pdf (accessed February 2014).

Ministry of Health and Population, Child Health Division. 2007. Community-Based Newborn Care Package (unofficial translation). Kathmandu, Nepal: Ministry of Health and

Population.

Ministry of Health and Population, Division of Health Services. 2011. Family Planning Services-National Work Policy 2011/12. Kathmandu, Nepal: Ministry of Health and Population

Ministry of Health and Population, Family Health Division, Government of Nepal. 2006. National Safe motherhood and Newborn Health- Long Term Plan 2006-2017. 2006.

Kathmandu, Nepal: Ministry of Health and Population. Available at

http://www.unfpa.org/sowmy/resources/docs/library/R092_MOHNepal_2006_SafeMotherhoodLongTermPlan.pdf (accessed February 2014).

Ministry of Health and Population, Family Health Division, Government of Nepal. 2010a. Female Community Health Volunteers Training Manual. Kathmandu, Nepal: Ministry of

Health and Population. Available at http://nfhp.jsi.com/Res/Docs/FCHVTrainingManual.pdf (accessed January 2013).

Ministry of Health and Population, Family Health Division, Government of Nepal. 2010b. National Female Community Health Volunteers Program Strategy. Kathmandu, Nepal:

Ministry of Health and Population. Available at http://nfhp.jsi.com/Res/Docs/FCHVStrategy2010.pdf (accessed January 2014).

Ministry of Health and Population, Family Health Division, Government of Nepal. 2010c. National Female Community Health Volunteers Program Strategy, Unofficial English

Translation. Kathmandu, Nepal: Ministry of Health and Population.

Ministry of Health and Population, Government of Nepal. 1997. Village Health Worker/Maternal Child Health Worker Job Description. Kathmandu, Nepal: Ministry of Health and Population.

Ministry of Health and Population, Government of Nepal. 2010. Nepal Health Sector Programme-Implementation Plan II (NHSP-IP 2) 2010-2015 Final Draft. Kathmandu, Nepal:

Ministry of Health and Population.

Ministry of Health and Population, Government of Nepal. 2013. Business Plan for Health Sector—F.Y. 2013/2014. Kathmandu, Nepal: Ministry of Health and Population. Available

at http://www.nhssp.org.np/health_financing/MoHP%20Business%20Plan%202013%20FINAL%2019%20Sept.pdf (accessed January 2014).

Nepal Family Health Program II. 2012. Female Community Health Volunteers: Technical Brief #1. Available at http://nfhp.jsi.com/Res/Docs/TB1-FCHV.pdf (accessed January 2014).

Nepal Family Health Program. 2007. Improving Access to Family Planning Services in Rural Areas: Technical Brief 6. Available at

http://www.jsi.com/JSIInternet/Inc/Common/_download_pub.cfm?id=12145&lid=3 (accessed January 2014).

New ERA. 2007. An Analytical Report on National Survey of Female Community Health Volunteers of Nepal. Available at

http://www.measuredhs.com/pubs/pdf/FR181/FCHV_Nepal2007.pdf (accessed January 2014).

Pradhan, Y.V., S.R. Upreti, K. Thapa, et al. 2011. “Fitting Community Based Newborn Care Package into the health systems of Nepal.” Journal of Nepal Health Research Council. 9

(19): 119-28. Available at http://www.ncbi.nlm.nih.gov/pubmed/22929840 (accessed January 2014).

Rai, S.K., G. Rai, K. Hirai, et al. 2001. “The Health System in Nepal-An Introduction.” Environmental Health and Preventive Medicine. 6: 1-8. Available at

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723647/ (accessed February 2014).

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NEPAL COMMUNITY HEALTH PROGRAMS

VII. AT-A-GLANCE GUIDE TO NEPAL

COMMUNITY HEALTH SERVICE PROVISION

Intervention Female Community Health Volunteer Village Health Worker Maternal Child Health Worker

Family Planning

Services/Products Information/

education

Counseling Administere

d and/or

provided

product

Referral Information/

education

Counseling Administere

d and/or

provided

product

Referral Information/

education

Counseling Administere

d and/or

provided

product

Referral

SDM/FAM

Condoms X X X X X X X X X

Oral pills X X X X X X X X X

Intramuscular

Depo-Provera X X X X X X X X X

Implants X X X X X X X X X

IUDs X X X X X X X X X

Permanent

methods

X

X

X

X

X

X

X

X

X

Emergency

contraception

HIV/AIDS Voluntary

counseling and

testing

Prevention of

mother-to-child

transmission (of

HIV)

X X X X X X X X X

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NEPAL COMMUNITY HEALTH PROGRAMS

Nutrition Infant and young

child feeding X X

Refer for

severe

malnutritio

n cases

X X

Refer for

severe

malnutritio

n cases

X X

Refer for

severe

malnutritio

n cases

Vitamin A

supplementation

6 -59 months

children

X X X

Deworming

tablets

supplementation

12-59 months

children

X X X

Maternal

and child

health

Misoprostol (for

PPH) X X X X X X

Zinc X X X X X X X X X

ORS X X X X X X X X X

Immunizations X X X X X X X X X

Chlorhexidine X X X X X X

Prevention

of anemia

Iron foliate tab

for pregnant and

postpartum

mother

X

X

X

X

X

X

X

X

X

Malaria Bed nets X X X X X X

Indoor residual

spraying

Sulphadoxine-

pyrimethamine

(for treatment of

uncomplicated

malaria)

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NEPAL COMMUNITY HEALTH PROGRAMS

Pneumonia

Treatment

(<5)

Cotrimoxazole P

tablet X X X X X X X X X

Neonatal

Infections

(Mgt. of Sepsis)

Cotrimoxazole P

tablet X X X X X X X X X

Gentamycine

injection X X X X X X X X X

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