Role of Community Health Volunteers Since the 2015 Nepal Earthquakes: A Qualitative Study

Objective: Nepal female community health volunteers (FCHVs) were the first available health personnel in communities during the 2015 Nepal earthquakes. This study explored the facilitating factors and barriers of the FCHVs during health emergencies. Methods: In-depth interviews with 24 FCHVs and 4 health managers from 2 districts in Nepal (Gorkha and Sindhupalchowk) were conducted using semi-structured interview guides. The qualitative data were analyzed using thematic analysis methods. Results: FCHVs were the first responders to provide services after the earthquakes and were well accepted by the local communities. Different models of supervision existed, and differences in the workload and remuneration offered to FCHVs were described. A wide range of disaster-related knowledge and skills were required by FCHVs, and lack of prior training was an issue for some respondents. Furthermore, lack of access to adequate medical supplies was a major barrier for FCHVs in the 2015 earthquakes. The 5 identified themes were discussed. Conclusion: Providing regular disaster response training for FCHVs and strong leadership from the public sector with sustained investments will be essential for increasing the capacities of community health workforces to prepare for and reduce the impacts of future health emergencies in resource-poor settings

Grassroots responses to violence against women and girls in post-earthquake Nepal: lessons from the field

Violence against women and girls (VAWG), including sexual violence, can increase after natural disasters. This article provides evidence from Nepal, a country where progress has been made on gender equality but VAWG remains an endemic problem. Research since the earthquakes involving women activists and non-government organisations indicates the continuing challenges facing disaster response efforts to prevent VAWG and protect women. Women and girls in camps and temporary shelters feel threatened and insecure due to the risk of violence and lack of privacy. Humanitarian aid, health care, and disaster responses can challenge VAWG, and offer safe spaces for women and girls to be established. This article draws on the views of grassroots women’s activists in Nepal and shares lessons for development and humanitarian workers about steps to be taken to challenge and minimise VAWG in emergency situations. © 2016 Oxfam GB

Cultural conception and silent acceptance of stereotypes : a critical study on nepalese women's situation

Master's thesis in global studies. School of Mission and Theology, May 201

‘It’s Breaking Quite Big Social Taboos’ Violence Against Women and Girls and Self-Defense Training in Nepal

Given the increased vulnerability to, and rise in reports of, sexual violence in post-disaster situations this article seeks to explore the role of self-defense programmes as a response to addressing violence against women and girls. It draws on the authors’ experience of post-earthquake Nepal in 2015. We argue that self-defense training can play a crucial role in challenging normative gender roles, raising confidence and self-esteem in girls and women during and post disaster, and call for further research to take place at the local level to explore this important issue further

The role of female community health volunteers in maternal health service provision in Nepal: A qualitative study

Nepal achieved the Millennium Development Goal 5 by reducing its maternal mortality by more than two thirds. This achievement has been credited to Female Community Health Volunteers (FCHVs) delivering basic Maternal Health Service (MHS) to pregnant women and mothers in their communities. This thesis explores the role of FCHVs in MHS provision in two regions (the hill and Terai ), from the perspectives of health workers, service users, and FCHVs themselves. Data were collected between May 2014 and September 2014 using qualitative methods. Semi-structured interviews were conducted with 20 FCHVs, 11 health workers and 26 women in villages. In addition, four focus group discussions were held with 19 FCHVs and field notes were taken throughout the data collection. Data were analysed using thematic analysis. The study found that most participants viewed FCHVs as a valuable resource in improving MHSs. In both regions, the FCHVs raised health awareness among pregnant women or mothers and referred them for check-ups. They shared health messages through mothers' group meetings and the meetings were also used for discussions around budgeting and finance, which sometimes left little time for discussion on health topics. Such activities, combined with the FCHVs’ lack of education, often proved to be counterproductive to their service provision. The roles of FCHVs were crucial in the hill region where there was limited access to professional healthcare. An important area of FCHVs’ work involved accompanying and assisting women during delivery. In addition, they distributed medicines, administered pregnancy tests and informed women about emergency contraception and availability of abortion services. The FCHVs used novel methods to share maternal health information: for example, they sang folk songs which contained health messages or visited new mothers with food hampers. Such services were invaluable for women in the remote hill villages, who otherwise would not have received any healthcare. In terms of their motivations to volunteer, this study found that FCHVs viewed their work as a form of basic human and social responsibility. In addition, they reported feeling empowered as a result of training and socio-economic opportunities. However, a lack of financial and non-financial incentives was the key hindrance for them in delivering their services, followed by their perception of community misunderstanding about their services. In addition, health system factors such as lack of medical supplies and irregular supervision hindered them in carrying out their role effectively. In general, volunteers in the Terai received less support than those in the hill region. Furthermore, FCHVs perceived a lack of respect by some health workers towards them. A lack of coordination between government health centres and non-governmental organisations was also noted. The thesis concludes with several recommendations for policy makers, practitioners and researchers in order to improve the services by FCHVs. These include providing the FCHVs with context specific support - financial and non-financial incentives, access to supplies, educational training, and supportive supervision - to enable them to deliver services more productively. Recommendations are also made for ensuring that FCHVs are recognised and respected for their contribution to MHSs by local health workers and their communities, as well as coordinating activities among local organisations that mobilise FCHVs to ensure that their services flourish in the future

Knowledge, attitudes, beliefs and behaviour of mothers of young children related to healthy eating: comparing rural and urban perspectives in Nepal.

Introduction: Mothers’ misconception of a healthy diet is one of the major causes of nutritional problems in preschool-aged children in Nepal and these beliefs and attitudes can result in the inappropriate feeding of young children. There is growing research on this topic in Nepal but very little from a public health perspective. This thesis has been designed to cover gaps in this understanding, especially mothers’ decision-making around feeding their children and is based on a general public health/behavioural change model conceptualised by Marks et al., (2001). Aim: The aim of this thesis was to compare food knowledge, beliefs, attitudes and behaviour related to feeding preschool-aged children in rural and urban Nepalese mothers. Objectives: The objectives were to: i. assess the knowledge, attitudes, and beliefs about nutritious food amongst mothers. ii. identify major barriers that are associated with existing cultures, religions and ethnic divisions; including public opinions for recommending healthy food for preschool-aged children. iii. assess health-seeking behaviour for rural and urban children of low socio-economic status. iv. determine factors that affect the availability of food locally. v. measure the mothers’ knowledge of and attitudes towards health promotion and food security. vi. evaluate the health-seeking behaviours for undernourished children and the reasons why. vii. seek mothers’ suggestions for a better nutritional environment. viii. evaluate the perceptions about healthy diet amongst the stakeholders, such as policy people, health professionals (low level to mid-level), pharmacists and spiritual healers. Methods: This research used a mixed-methods approach in two different locations in Nepal, including a quantitative survey and qualitative focus group discussions. The questionnaire comprised open-ended and structured questions on knowledge, beliefs, and attitudes about nutritious food, child-feeding patterns, food recommendations, major barriers, food insecurity, and health-seeking behaviours. A descriptive data analysis approach was used to analyse the quantitative data by using SPSS version 21.0. The qualitative focus groups aimed to collect in-depth information around attitudes and beliefs and data were thematically analysed. Results: A total of 524 mothers completed the questionnaire. All had children aged 36 – 60 months and were no longer breastfeeding at the time, from rural (n=228) and urban (n=296) localities. In addition, 50 key informants participated in seven focus groups. The findings revealed that 66% of children were being fed by mothers and only 5% by fathers. The major barriers to recommending nutritious foods perceived by mothers included: lack of knowledge (19%); high prices (45%); and cultural influences or beliefs (13%). Almost 12% of mothers never fed colostrum to their children and 34% were unable to identify nutritious food when shopping at grocery stores, whilst 19% lacked food at home. Nearly 57% of children had been taken at least once to a spiritual healer for treatment and 16% more than once. The focus group analysis suggested that important factors associated with knowledge, attitudes, and beliefs about a healthy diet are: poverty, education level, strong cultural beliefs, family size, household income, time, and a growing preference for fast food. Conclusions: Levels of knowledge on what types of food are nutritious were low in both urban and rural mothers and their attitudes and views appear to be poorly-informed. Mothers from both rural and urban communities had great faith in spiritual healers. This study suggests that a public health approach is needed to address nutrition problems associated with behaviour and revealed major barriers to maternal knowledge, which were associated with poverty, resources, mothers’ education level, and climate change. Diversified and conflicting views were also found to be a major barrier preventing mothers from making better decisions. Thus, special attention should be paid at the practitioner and policy-maker level on appropriate interventions and approaches, based on changing these cultural beliefs and behaviours, to help reduce undernutrition in poor communities