{"id":40005,"date":"2024-08-28T08:47:46","date_gmt":"2024-08-28T08:47:46","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjgh\/?p=40005"},"modified":"2024-08-28T08:47:46","modified_gmt":"2024-08-28T08:47:46","slug":"socio-economic-experiences-of-female-community-health-volunteers-matter-insights-from-nepal","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjgh\/2024\/08\/28\/socio-economic-experiences-of-female-community-health-volunteers-matter-insights-from-nepal\/","title":{"rendered":"Socio-economic experiences of female community health volunteers matter: insights from Nepal"},"content":{"rendered":"

 <\/p>\n

\u201cI have not been able to put paddy seeds for plantation while others [in the village] have already done this. Women in the village don\u2019t even have time to go for check-ups, but they want me to stay with them from the morning to the evening during their labour. What should I do? I cannot work for villagers only. I need to look after my animals. I need to eat.\u201d (Female community health volunteer in remote Nepal).<\/em><\/p>\n

This quote illustrates how women health volunteers have to fit their voluntary role into their everyday work (see original research published in Journal of PLOS Global Health<\/em><\/a>)<\/em>. Indeed, in many resource-poor health systems, there is a dependency on unpaid volunteers, often women. However, women volunteers experience difficulties on the work front that are not experienced by men, for example, struggle between household and work obligations, and a lack of job prospects. Yet, their socio-economic need is hardly acknowledged in global health programmes. In this blog, we highlight the views and experiences of female community health volunteers (FCHVs) from Nepal, which is based on our recent publication.<\/a><\/p>\n

In Nepal, about 50,000 volunteers, all women, form a vital human resource for both government and non-government agencies delivering primary healthcare at community level. Their contribution to maternal and child health is recognised globally. Their role is crucial especially in remote areas<\/a>. For example, they provide health education to pregnant women and mothers, accompany women to health centres and make referrals when needed. They are also crucial for screening of non-communicable diseases like hypertension<\/a> and diabetes.. Yet, little is known about how these women, often from poorer strata in society, view volunteering<\/a>. A common notion is that\u00a0 FCHVs are motivated by the social recognition for their services and that paying them is unnecessary. Yet, these views represents the views of policymakers and managers<\/a>, who are male, salaried, public servants, thereby ignoring gender bias inherent in women volunteers.<\/p>\n

In rural Nepal the socio-economic status of women is often low, not just that of FCHVs. The latter are likely to spend considerable time looking after their families, which like the volunteering, generates no income for them (i.e. it is unpaid care work) and leaves them economically insecure. In 2014, Sarita studied several villages in different areas of Nepal. Since then there has been little change in the volunteering programme except that more and more responsibilities are given to volunteers<\/a>. Sarita\u2019s familiarity with the study villages, her gender (being a female) and her ability to speak Nepali language might have led the volunteers to open up about the issues they faced.<\/p>\n

In our study<\/a>, we looked at the data across individual, community and organisational levels. At the individual level, we found that all FCHVs were committed to their unpaid volunteering work. Yet, their experiences of volunteering were different. Some spoke of implications for their livelihoods, high levels of out-of-pocket expenditure and inadequate family support which stressed volunteers who were already overburdened with family and farm responsibilities. However, some saw volunteering as a chance to earn some money (small amounts in the form of training and travel allowances) and others saw it as a way \u00a0to improve future employment.<\/p>\n

At the organisational level, bureaucratic emphasis on recording and reporting of health activities undermined volunteers\u2019 motivation. Many reported being asked by paid health workers to complete formal reporting to local health centres. This took up a lot of their time, and it was particularly hard for older and illiterate volunteers. In addition, volunteers reported lack of respect from local health workers that discouraged them from volunteering.<\/p>\n

At the community level, the social experience of working in one\u2019s own village was not the same for all. While community recognition of volunteers\u2019 work was seen as a motivator, most volunteers viewed that they were not given due respect by fellow community members. Community members mistook volunteers as paid health workers often due to their involvement in medicine distribution, a rare bi-annual activity.<\/p>\n

We found that women from some of the poorest backgrounds can be highly motivated to volunteer. Yet, insufficient social and economic support across individual, organisational and community levels undermined this motivation. This has consequence for their livelihoods, and thus broader efforts to meet primary health care. International donor agencies and the Government of Nepal must ensure that \u00a0FCHVs are compensated for their services. Moreover, communication training is necessary for health workers to ensure that they use respectful language with volunteers, alongside community awareness programmes on the role of volunteers.<\/p>\n

 <\/p>\n

About the authors<\/strong><\/p>\n

Sarita Panday<\/a> (PhD)- She is a lecturer in Global Public Health in School of Health and Social Care in the University of Essex. She has expertise in maternal health and community health systems, and has been conducting research in Nepal for almost a decade.<\/p>\n

Edwin van Teijlingen (PhD) \u2013 He is trained as a medical sociologist and works as Professor of Reproductive Health at Bournemouth University.\u00a0 He has been conducting research in Nepal for the past two decades.<\/p>\n

Amy Barnes- She is Senior Research Fellow in University of York. She has over 15 years of experience of community- and policy- engaged scholarship focused on building skills and capacities to evidence and take collective action to address determinants of health and inequality.<\/p>\n

Competing interests:<\/strong> None<\/p>\n

Handling Editor:<\/strong> Neha Faruqui<\/p>\n","protected":false},"excerpt":{"rendered":"

  \u201cI have not been able to put paddy seeds for plantation while others [in the village] have already done this. Women in the village don\u2019t even have time to go for check-ups, but they want me to stay with them from the morning to the evening during their labour. What should I do? I […]<\/p>\n

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