By Sharmina Manandhar
Community health volunteers provide a crucial link to health services across Nepal, where a UNICEF-European Union intiative has helped to bring a big drop in malnutrition.
MANGALSEN, Nepal, 28 July 2015 – It is a happy day for Madan Sunar and his family. After a three-month stay in hospital, the 4-year-old from Achham district, in the Far-Western region of Nepal, is finally going home with his parents and 2-year-old brother.
Madan was brought to the district headquarter hospital in Mangalsen after being diagnosed with severe acute malnutrition.
“He was born in seven months. He was very small,” says Madan’s mother. “He got very sick and lean. He was not even two kilograms then.”
Madan’s family first tried to treat him with home-made herbal medicines.
“Whatever I tried, it didn’t work,” she says. “His condition got worse.”
It was the local health workers who advised her to take Madan to the district hospital, she said.
“They told me if I didn’t take him, he would not survive,” she says.
Madan is one of thousands of children whose lives have been saved by the timely interventions from the local female community health volunteers (FCHVs) of Nepal.
Clad in light blue saris, FCHVs criss-cross this Himalayan nation providing basic health care services and information to improve child and maternal health. Often seen as the front line of Nepal’s defense in health, the FCHVs act as a crucial link between health services and the needs of communities.
Global initiative, local action
Training and mobilizing more than 50,000 health volunteers to promote child and maternal nutrition has been an integral aspect of the national nutrition security programme, supported by UNICEF and funded by the European Union (EU). The programme is part of a four-year UNICEF/EU global initiative, with multiple regional, national, and community partners, to permanently reduce the rates of under-5 and maternal undernutrition.
In Nepal, EU and UNICEF partnered to support the Government in implementing activities to improve nutrition security in 29 districts that have the highest rates of undernutrition. At national and district levels, it helps promote government and community ownership of development processes, including training, mapping and the mobilization of community networks, such as women’s groups.
The programme uses a multi-sector approach, combining nutrition, health, water and sanitation, agriculture and social protection interventions to maximize the positive effects on child and maternal nutrition.
Much improvement
Mithu Bhul is the mother of three children in the village of Khati, in Achham district.
Two years ago she found out that her son Roshan, 4, was suffering from malnutrition.
“The FCHV measured his arm and said he was suffering from malnutrition,” she says. “She told me to take him to hospital.”
The FCHVs use a Mid-Upper Arm Circumference (MUAC) tape to determine a child’s nutrition status. Any child with a measurement in the red area of the tape is considered severely malnourished and is referred to the nearest health centre.
At the centre, the child is treated with ready-to-use therapeutic food (RUTF). Mothers and care givers are counselled on preparation of optimal complementary food, as well as using multiple micronutrient powder, which fortifies food with essential nutrients.
Health workers also promote awareness about proper child and maternal nutrition, as well as sanitation and hygiene.
“Compared to earlier, there has been much improvement,” says Laxmi Bhul, an FCHV in Achham district. “People started feeding women and children good food because they are aware that babies will be healthy.”
Nepal has made tremendous progress towards improving the health and survival of its children in the last 25 years. The under-5 mortality rate has dropped significantly, from 142 per thousand live births in 1990 to 38 in 2014 – making Nepal one of the countries to achieve Millennium Development Goal 4– reducing child mortality by two thirds by 2015.
“Compared to three years ago, more pregnant women come to health post for check-ups. People don’t miss immunization. I am very happy about it,” Ms. Bhul says.
“Every house has a toilet now. People are aware of hygiene. These changes of mindsets have already occurred now.”