title: Strengthening Nepal's Female Community Health Volunteer network: a qualitative study of experiences at two years.
abstract: BACKGROUND
  Nepal's Female Community Health Volunteer (FCHV) program has been described as an exemplary public-sector community health worker program. However, despite its merits, the program still struggles to provide high-quality, accessible services nation-wide. Both in Nepal and globally, best practices for community health worker program implementation are not yet known: there is a dearth of empiric research, and the research that has been done has shown inconsistent results.
  
  
  METHODS
  Here we evaluate a pilot program designed to strengthen the Nepali government's FCHV network. The program was structured with five core components: 1) improve local FCHV leadership; 2) facilitate structured weekly FCHV meetings and 3) weekly FCHV trainings at the village level; 4) implement a monitoring and evaluation system for FCHV patient encounters; and 5) provide financial compensation for FCHV work. Following twenty-four months of program implementation, a retrospective programmatic evaluation was conducted, including qualitative analysis of focus group discussions and semi-structured interviews.
  
  
  RESULTS
  Qualitative data analysis demonstrated that the program was well-received by program participants and community members, and suggests that the five core components of this program were valuable additions to the pre-existing FCHV network. Analysis also revealed key challenges to program implementation including geographic limitations, literacy limitations, and limitations of professional respect from healthcare workers to FCHVs. Descriptive statistics are presented for programmatic process metrics and costs throughout the first twenty four months of implementation.
  
  
  CONCLUSIONS
  The five components of this pilot program were well-received as a mechanism for strengthening Nepal's FCHV program. To our knowledge, this is the first study to present such data, specifically informing programmatic design and management of the FCHV program. Despite limitations in its scope, this study offers tangible steps forward for further research and community health worker program improvement, both within Nepal and globally.
authors.affiliation: Possible, Bayalpata Hospital, Ridikot, Achham, USA. daschwarz@gmail.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Schwarz
authors.forename: Ranju
authors.initials: R
authors.lastname: Sharma
authors.forename: Chhitij
authors.initials: C
authors.lastname: Bashyal
authors.forename: Ryan
authors.initials: R
authors.lastname: Schwarz
authors.forename: Ashma
authors.initials: A
authors.lastname: Baruwal
authors.forename: Gregory
authors.initials: G
authors.lastname: Karelas
authors.forename: Bibhusan
authors.initials: B
authors.lastname: Basnet
authors.forename: Nirajan
authors.initials: N
authors.lastname: Khadka
authors.forename: Jesse
authors.initials: J
authors.lastname: Brady
authors.forename: Zach
authors.initials: Z
authors.lastname: Silver
authors.forename: Joia
authors.initials: J
authors.lastname: Mukherjee
authors.forename: Jason
authors.initials: J
authors.lastname: Andrews
authors.forename: Duncan Smith-Rohrberg
authors.initials: DS
authors.lastname: Maru
mesh_terms: D000328:Adult; D003150:Community Health Workers / Q000193:education / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D009390:Nepal; D010865:Pilot Projects; D015397:Program Evaluation; D036301:Qualitative Research; D012189:Retrospective Studies; D014838:Volunteers / Q000193:education