COMPRENSIÓN DE ORACIONES

Health workers from an NGO in the hill region expressed their concerns over the

government health workers for not showing interest in the health activities implemented

by the NGOs. As the public health centres were hesitant to take ownership of the NGO

work, the long-term effect of the work was uncertain.

One NGO worker was worried about the long-term functioning of the mothers’ group in

the absence of public health centre support:

“If we want sustainability in the mothers' groups then public health centres should support them. Our NGO is supporting revival of the groups which should have been done by related health organizations.” HW6.

175 Another NGO worker working in the remote hill village mentioned the problems

associated with supervision of volunteers:

“It is written in their work book that the government health workers (village health workers, and maternal and child health workers) should attend the mothers’ group meeting; however, they do not attend it. If I am there, then I am the only one; otherwise women in the group meet themselves. The group has been formed with FCHVs who are mobilised from the heath post. However, there is no work from the health post for the sustainability of this group function.” HW5.

A NGO worker also highlighted the difficulties associated with working with the

government health workers:

“For NGOs, it is difficult to coordinate with health workers, as they demand some allowances. It feels as if the health workers from the government are working for NGOs and not for their own people, whilst we are trying to strengthen the government programme.” HW6.

He further highlighted the challenges faced by NGOs:

“There is also some duplication of the programmes creating unhealthy

competition among NGOs working in the same region. If different organizations run similar programmes in the same time, where should the community people participate? For example, a NGO (xxx) is working in the village (xxx) and has created a mothers’ group with 15 members only as compared to the average size of mothers’ groups of about 30 members in each village unit. This has created confusion among mothers about which group to attend.” HW6.

6.9 Chapter Summary

This chapter complemented Chapter Five where variations in the MHS delivery by

176 or hindered MHS delivery by FCHVs, and these were classified into three levels:

individual, community and health centre.

At the individual level, four key themes were described: (a) older age of FCHVs, (b)

education of FCHVs, (c) motivation to volunteer and (d) financial and non-financial

concerns with respect to volunteering.

Older FCHVs were committed to their work, as they valued the service over the money,

and some of them also served for religious reasons. However, a few FCHVs who were

aged around sixty were volunteering despite some physical problems, as they wanted

their family members to replace them, or expected some financial benefits before they

leave.

FCHVs were delivering MHS regardless of their educational status. As compared to the

volunteers who lacked education, educated volunteers in the hill villages had received

additional training on administering urine pregnancy tests and informing women of the

availability of abortion services. In the Terai, the educated volunteers were involved in

social and political activities and some of them had full-time jobs. On the other hand,

illiterate FCHVs lacked the necessary skills to educate mothers and record their health

activities. Moreover, the illiterate FCHVs were not approached by educated women, as

seen in the Terai.

FCHVs reported four key reasons for their motivations to volunteer: (a) recognition of

the importance of the role by FCHVs themselves, (b) opportunities for training or

learning, (c) desire for employment and (d) support of family and friends. While they

were motivated by altruistic reasons as well as other benefits of volunteering, the

majority of FCHVs’ and health workers expressed the need for financial and non- financial incentives to undertake everyday activities. For example, the volunteers in the

177 asked for bed nets and bicycles. While the FCHVs from both regions asked for the basic

support, the FCHVs in the Terai were more vocal about their issues. The available

incentives widely varied in the Terai, which made the FCHVs resentful and this simply

served to demotivate them.

At the community level, FCHVs enjoyed the community recognition they achieved as a

result of their role in treating simple diseases in the villages. Furthermore, the praise by

health workers and the service users and the uniform, name-plate and identity-card for

FCHVs afforded them a status within their community. However, the same tangible

rewards sometimes caused community misunderstanding among villagers thus

challenging the volunteer status of FCHVs. Many FCHVs expressed their concerns about community members’ perception of them as paid workers or providers of either unnecessary or detrimental medicines. This is because they were often mobilised in

national health campaigns without adequate support from the health centres and the

communities. Furthermore, some ethnic groups such the Chepang in the hill region and

Madhesi and Muslims in the Terai did not access the services of FCHVs because of the

misunderstanding of modern healthcare and existing cultural practices.

At the health centre level, differences were reported between the support available to

FCHVs in the Terai and the hill regions. In the hill villages, FCHVs were well

supported by both public health centres and NGOs in terms of their selection, training

and supervision, including access to supplies, whilst such services were not available in

the Terai. Though health workers often praised the contribution of FCHVs in MHS

provision, some volunteers reported rude behaviours of some health workers towards

them. In addition, a lack of coordination between the government health centres and

178 Overall, all the volunteers were motivated to serve their communities as they viewed

their work as a social responsibility, enjoyed community recognition, and recognised

the importance of role by FCHVs themselves. However, they were highly concerned

about financial and nonfinancial incentives in order for them to work well. Other key

factors that caused barriers in their ability to deliver services were their older age,

illiteracy, community misconception of their roles, and inadequate support from health

centres. Furthermore, a need for cordial relations between government health workers

179

Chapter Seven

Discussion

7.1 Introduction

This chapter begins by summarising the key findings from the previous two chapters

(Chapter Five and Six). This is followed by a brief justification on the selection of key

themes for the discussion which are: (1) MHSs offered by FCHVs, (2) their motivation

to take part in volunteering, and (3) the challenges they faced in delivering services.

Each of these themes is interpreted with respect to current literature on CHWs. Finally,

the strengths and limitations of the research approach used in this PhD study are

highlighted.