Nepal's 'health army' has transformed the lives of people in remote areas
Volunteers have been transforming the lives of villagers, delivering primary medical care and saving mothers from often certain death
Bibek Bhandari in Jumla
For 18 years, Bishnu Buda has been working as a health volunteer in mid-west Nepal's Jumla district.
From providing primary medical care to counselling women on safer motherhood, Buda is a part of the country's army of 52,000 Female Community Health Volunteers (FCHV), working in far-flung districts with limited access to medical infrastructure.
As the world marks International Volunteer Day today, Nepal is celebrating 25 years of its FCHV programme. Its aim was to have village health care provided by someone from the community, chosen by the community and working for the community after completing basic training.
"I've had the most valuable opportunity of contributing towards my society," Buda, 51, said. "I can see the differences."
In the sleepy village of Urthu, Buda has transformed the community's patriarchal perspective.
"Women shouldn't always be confined to their houses," Buda said. "They should also participate in the community's development."
As a health promoter, Buda said she was just doing that. In her blue sari uniform, her primary job is to visit pregnant women and newborns, advocating antenatal check-ups, hospital delivery and nutrition for mother and child.
As Buda checks up on 22-year-old Kamala Bista, pregnant with her second child, she hands over a sachet of iron pills.
"We didn't know anything then, and a lot of women and children died," said Bista's mother-in-law, Paryou Bista. "Now, if there are any pregnancy-related complications, they refer them to the healthcare facility, so there's less risk of someone dying."
In remote parts of the landlocked country, reaching the nearest health-care facility can mean a treacherous days-long walk. A difficult labour can mean death for mothers and newborns.
The presence of FCHVs in these rural regions means women are encouraged to attend antenatal check-ups and get to hospital to deliver, or in the presence of trained birth attendants.
In Jumla, half of births last year were in a health facility. The maternal mortality rate has improved, with no deaths reported this year.
On a national level too, Nepal has drastically reduced maternal, infant and child mortality. According to the 2011 Demographic and Health Survey, infant mortality has dropped 42 per cent and under-five mortality 54 per cent over the past 15 years. The maternal mortality rate tumbled from 850 per 100,000 births to 281 from 1990 to 2006.
Dr Kiran Regmi, the director of Nepal's Family Health Division which oversees the FCHV programme, credits the country's voluntary workforce for the improvement in the lives of mothers and children.
"They're working from grassroots level and are assisting in achieving the [United Nations] Millennium Development Goals for Nepal," she said.
According to the Millennium Development Goals Progress Report 2013, "Nepal is on track" and "targets for poverty reduction, maternal mortality, and girls and boys in primary school education are either achieved or likely to be achieved".
In places like Jumla, FCHVs are also playing a key role in promoting hygiene and sanitation.
According to Nepal's Department of Health Services' 2012 report, FCHVs treated more than 13,000 acute respiratory infections, 8,260 cases of diarrhoea and 7,280 cases of pneumonia, with no deaths recorded.
"They act like messengers to people, advocating for them on health issues," said Leela Bikram Thapa, the district’s Senior Public Health Officer, citing their contribution towards strengthening the district's and also the country's health standards.
Despite the limited pay and government benefits they receive, FCHVs like Buda have dedicated their lives to helping people. With nine years until retirement, she said the experience had been humble and gratifying.
"The respect I get from the community, the recognition I have, and the results I see from my service motivates me to continue working," Buda said.