Kathmandu, 10 March: On the occasion of 114th International Women’s Day, Public Services International (PSI) launches a video highlighting the challenges faced, as well as victories won, by Community Health Workers (CHWs) in Nepal. CHWs is an only-women workforce which serves as the link between the community and government health services. Recognising and fulfilling their rights will go a long way in empowering women who have been working tirelessly to keep our society, communities and children healthy.    

The video provided a platform to CHWs to share their stories and successes. CHWs, more commonly known as Female Community Health Volunteers (FCHVs) in Nepal, play a crucial role in providing essential healthcare services to underserved communities. By going door-to-door on a daily basis, they perform tasks such as detection and treatment of common childhood illnesses, distribution of oral rehydration solution and zinc for diarrhoea, and ensuring pre- and ante-natal care for pregnant women and newborn babies. They are also responsible for health education and providing information about different government programmes, schemes, and campaigns.  

Despite their critical work, CHWs encounter numerous challenges in carrying out their duties, including inadequate resources, limited access to training, and precarious working conditions. They are denied recognition as regular workers and hence, do not receive benefits that government employees receive like maternity benefits, pension, social security etc. They do not even receive regular salaries. Instead, they only get very low incentives according to specific tasks. 

“I do not have any fixed working hours. I have to be available 24 X 7 whenever people need assistance, say during delivering a child. The terrain I cover is mountainous and it takes a lot of effort to reach each household for tasks like health promotion. Despite working so hard, we are neither compensated properly, nor provided other support like maternity benefits, social security, pensions etc. In my municipality, CHWs have started to get NPR 3000 (EUR 21) per month. But in many parts of the country, CHWs are not given a single penny as salary. Our unions and PSI have been campaigning for recognition of community health work as work so that we get salaries and other benefits that we deserve,” said Basanti Maharjan, President, Health Volunteers' Organization of Nepal (HEVON).

The video aims to raise awareness about the vital role of CHWs and advocate for their rights and recognition. A glimpse of their work and efforts can be seen in PSI’s film A Day in the Lives of South Asia’s Community Health Workers. 

To challenge these exploitative conditions, CHWs have been unionising and advocating for their rights through protests and engagement with the authorities. And their struggles have borne fruit. A few provinces have started to recognise their work and provide different kinds of support. In Nagarjun municipality, for instance, the local government is giving them a monthly stipend of NPR 5000 (EUR 34) for their services. This recognition of their invaluable contributions marks a significant step towards ensuring CHWs financial security and well-being. 

Similarly, in Bagmati province, CHWs have achieved a milestone by obtaining full health insurance coverage. This essential benefit provides them with much-needed support and protection against unforeseen medical expenses, ensuring their access to affordable healthcare services. 

Furthermore, in Bansgadi province, CHWs have recently received promising assurances of inclusion in the social security scheme. Under the scheme, they will receive benefits such as health treatment, maternity benefits, and old age protection. They will also be eligible for loans up to NPR 1200000 without any collateral.  

“While we are happy with these developments, we recognise that these are incremental steps towards the larger goal of being regularised and recognised as workers. Our work during Covid-19 should not be forgotten. We were the backbone of Covid-19 response, despite the lack of personal protective equipment and other safety measures. Our tireless work has ensured reduction of maternal and infant mortality in Nepal. We have a strong case for our rights,” Gita Devi Thing, President, Nepal Health Volunteer Association (NEVA). 

PSI and affiliates continue to champion the rights of CHWs in South Asia through its Charter of Demands, released in August 2023. This comprehensive document outlines key priorities for ensuring the fair treatment and recognition of CHWs across the region. 

"The recent victories of CHWs in Nepal are a testament to their resilience and dedication. PSI remains committed to advocating for their rights and well-being of. The struggles have borne fruit, albeit minimal. The Charter of Demands is a guiding document as it provides a comprehensive view of all the demands that need to be met for fair and equitable working conditions," said Jeni Jain Thapa, Nepal project coordinator of PSI. She added, “The Government of Nepal talks about its efforts of improving gender equality in the country. By giving CHWs their due, the government can show its commitment to emancipation of women and bring about real change.” 

As Nepal's healthcare system grapples with ongoing challenges, PSI, NEVA and HEVON remain steadfast in their commitment to supporting CHWs and advocating for their rights and dignity. 

For media inquiries and interview requests, please contact: 

Jeni Jain Thapa, Project Organiser – PSI, Nepal 
Mob: +977 9841499169 
Email: jeni.jain.thapa@world-psi.org