The Impact of the COVID-19 Pandemic on Community Health Workers: A Case Study of Far West Nepal

BACKGROUND: As of April 2023, Nepal has had over 1,000,000 cases of COVID-19 and over 12,000 deaths. Most of the country's population of 30 million lives in rural settings. Since 1988, the Government of Nepal has utilized Female Community Health Volunteers (FCHVs) as liaisons between communities and the healthcare system. In 2015, the Government collaborated with a local non-profit organization, Nyaya Health Nepal (NHN), and a US-based non-profit organization (Possible) to improve upon the FCHV model and create a community health worker (CHW) program to serve the district of Achham in the remote Far West region of the country. The counseling that the CHWs provide is largely focused on maternal health --antenatal and postnatal care, pregnancy surveillance-- and children under the age of 2, and during the pandemic, the CHWs were forced to shift their model of counseling from in-person to virtual counseling over the phone. METHODS: In this retrospective cross-sectional study, we qualitatively reviewed narrative data of the CHWs' experiences, which were collected after the second wave of the pandemic in March-April 2021. Convenience sampling was used with a sample size of 27 CHWs. Along with demographic variables, the questionnaire asked CHWs to explain any challenges faced while providing virtual counseling, and provide any suggestions that they felt could have improved their experience. The handwritten documents were digitized, translated from Nepali into English, and verified to ensure the highest degree of completeness and accuracy. The data was imported into Microsoft Excel to facilitate qualitative analysis, and the responses were evaluated for prominent themes and included unique individual experiences to ensure that everyone's voices were represented. FINDINGS: We identified three key challenges: 1. Difficulty establishing a connection for phone counseling; 2. Inability to identify pregnant patients early on in their pregnancy to provide adequate antenatal care; 3. Lack of privacy or confidentiality for the patient when attempting to talk about sensitive subjects. It would be beneficial to document any changes in processes that that made the CHWs' work more efficient or effective, in the event of a future medical emergency or natural disaster that would prevent the CHWs from doing in-person counseling.

Author dc:creator

• Venkatraman, Chinmayee Kamakotika

Contributors dc:contributor

• Kharel, Ramu
• Wells, C. Edward
• Chang, Mary

• COVID-19
• Delivery of Health Care
• Health Services Accessibility
• Maternal Health Services
• Nepal
• Rural Health Services
• Community Health Workers

Language dc:language

en

Identifier

1596185295

OAI identifier oai:identifier

oai:utswmed-ir.tdl.org:2152.5/10835