Mangala BK of Mangalsen Municipality-5 in Achham has been working as a community health volunteer for 28 years. His career as a health worker has been fraught with pitfalls such as derisory wages and caste discrimination.
“The opportunity to become a community health volunteer came to me by accident,” said Mangala. “About two decades ago, health workers from the so-called upper caste did not want to visit Dalit households. People in my community therefore supported me to become a community health worker so that Dalits were not excluded from health care.
“When I started, I was assigned to visit non-Dalit households, but most people prevented me from entering their homes,” BK said. “I suffered public humiliation and I was also the victim of violence because of my caste. But I persevered.
Mangala describes her early days in health care as stressful, but over the years she has been rewarded for her work in the rural health sector in Achham.
“Mangala has helped many people who needed medical assistance and advice. She has transported many sick and pregnant women to hospital several times. Mangala is a boon to people in her community and outside, ”said Ganga Bista, a resident of Mangalsen-5.
“Ten years ago I had a difficult pregnancy and Mangala was there to help me and take me to the district hospital for a safe delivery,” Bista said.
Women community health volunteers like Mangala have long asked the government for competitive salaries and benefits, but the authorities concerned have ignored their demands.
The allowance for female community health volunteers is paid by the federal government through local units. They receive an annual allowance of Rs 10,000 for uniforms and Rs 12,000 for transportation costs and receive Rs 400 for any meetings or programs they attend.
But the incentives they receive from the state are not enough, health workers say.
Women community health volunteers have been the backbone of rural health care in the country for several decades now. They have actively participated in almost all government-run health programs in rural areas.
From sensitizing the rural population on the importance of the use of contraceptives such as condoms and contraceptive pills to promoting prenatal and postnatal check-ups, women community health volunteers have played a major role in curbing the population growth and save women from pregnancy-related problems. complications.
Mathura Dhungana, also a health volunteer, says that female health volunteers have a major role to play in the health care of rural villagers, especially women.
“We are acting as an intermediary for pregnant women to reach full term and for a safe delivery,” Dhungana said. “Villagers are always tied to superstitions and expectant mothers are afraid their families will take them to witch doctors instead of a doctor. Therefore, our work is not only limited to providing medical services to patients, but also to educating the villagers about the importance of regular check-ups.
According to Dhungana, until a few decades ago, the high rate of infant mortality was a major problem in the villages. But the presence of women community health volunteers in rural areas has helped reduce the infant mortality rate.
“Since most women have opted for home births in the past, complications such as premature birth and low birth weight in babies have caused infant deaths. But now pregnant women are aware of the availability of maternity services through us or from a health post, ”she said.
Nepal succeeded in reducing the maternal mortality rate from 539 in 1996 to 239 in 2016, for which the country received the Millennium Development Goals award. This achievement would not have been possible without the hard work of the women community health volunteers.
Another health volunteer, Amrita Aauji, who is also a health volunteer, says she has organized trainings and workshops for local women on safe motherhood services, especially the use of the ointment for the umbilical cord, fetal foot measurements and the importance of giving breast milk to newborns.
“Currently, there are no women in the villages who opt for home births. When I see women giving birth in an institution, I feel like I have done my job well, ”said Aauji. “We have worked tirelessly to improve access to healthcare for the rural population and it is time that we received due compensation for our hard work. ”
According to health volunteers in Achham, deaths of pregnant women and children under five from pneumonia, malaria, diarrhea, malnutrition and chickenpox have declined significantly over the past decade.
For two years, the country has been facing an assault from the Covid-19 pandemic. In Achham, female community health volunteers have been deployed to the villages to raise awareness about Covid-19 and inform the rural population of the security measures and the mandate in the event of a pandemic. But they did not receive compensation for their hard work, says Durga Devi Bohara, a female community health volunteer in the rural municipality of Bannigadi Jayagad.
According to the District Health Unit, there are currently 941 female community health volunteers in Achham.
Meanwhile, Jhana Dhungana, head of the district health office, said the government had not been negligent towards its community health volunteers.
“The government has regularly provided stipends to women community health volunteers,” he said. “Volunteers also receive incentives from the local government. “