Perceptions of Mothers in Nepal on the Roles of Female Community Health Volunteers in Providing Iron Folic Acid and Referral to Antenatal Care
Leeza Sharma *
Micronutrient Initiative, Ottawa, Canada.
Marion Roche
Micronutrient Initiative, Ottawa, Canada.
Macha Maharjan
Micronutrient Initiative, Kathmandu, Nepal.
Deepika Chaudhery
Micronutrient Initiative, New Delhi, India.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Nepal led a 9 year national scale-up of Iron Intensification Program to address maternal anemia, utilizing an integrated delivery-platform that extended distribution of Iron Folic Acid (IFA) through peer-selected female community health volunteers (FCHVs). The study's purpose, as a segment of a larger-study was to understand the perceptions and acceptability of FCHVs to mothers in Nepal and how this influenced their acceptance and access to healthservices, antenatal-care (ANC), and access to IFA during pregnancy.
Methods: Twelve districts were purposively selected to represent Nepal's diverse ecological-zones (Mountain, Hills and Terai) and exposure to the intervention. One focus group discussion (FGD) with 6-10 mothers was conducted in each district (n=96). Interviews were conducted in Nepali, transcribed verbatim, then translated into English. Coding done in Atlas. ti identified mothers' perspectives of FCHVs, descriptive context, barriers and enablers for accessing ANC and IFA.
Results: Mothers suggested that FCHVs are highly valued for their roles in providing IFA during pregnancy, referrals to ANC, and for advice. Remote areas with least access to healthcare expressed greatest appreciation for FCHVs' role in providing treatment and counseling for all conditions, but especially maternal-child health. However, in some peri-urban areas, FCHVs were perceived as having low-literacy and there was a preference for facility-based service and health professionals.
Conclusions: Mothers in Nepal perceive FCHVs as integral for providing access and counseling for IFA and referral to ANC; however, with an emerging preference for higher trained professionals in some regions, minimum education standards and trainings for FCHVs may help maintain the relevance of program going forward.