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  • Title: Urban community health volunteers.
    Author: Chaulagai CN.
    Journal: World Health Forum; 1993; 14(1):16-9. PubMed ID: 8439362.
    Abstract:
    An evaluation was made of the effectiveness of an urban community health volunteer programme in Pokhara, Nepal, in sensitizing and motivating people for the improvement of health knowledge and skills and the use of services. Despite weaknesses and inadequate management support, there has been a sharp increase in coverage by the health services. If management support were properly developed the programme could undoubtedly play a vital role in raising health standards. It was clearly demonstrated that the utilization of services can be increased if access to them is improved. In Nepal, the village health worker program in urban areas has not been effective; the volunteer program has never been tried. In order to increase use of basic health services, a program was initiated in 1987 in Pokhara to survey hospital and health utilization rates and baseline demographic conditions. Urban community health volunteers (32) were trained to conduct a demographic and health survey, to educate and motivate people to use healthy and hygienic practices, and to use appropriate health services. Outreach clinics were established in each ware; home visits were made by the community health volunteers. Clinics attended to prenatal care, immunization, growth monitoring, family planning, and health education. Of the 32 volunteers, 14 males and 8 females dropped out due to the scarcity of incentives, lack of time, and no recognition. An evaluation of the program over the prior two years of operation was conducted in January, 1991, in order to assess the impact on knowledge, skills, behavior, and use of facilities. A random sample of 394 mothers with children aged 5 years, who were registered in the health ward and population registers, was selected for in-depth interviews. The results showed that only 70 of the mothers knew of community health volunteers in the wards; 56 had been in direct contact. 49 of those who knew about the volunteers considered the program helpful. 149 mothers knew about the mobile clinic in their wards; 100 of these mothers had used services in a hospital clinic. There was a lack of coordination among potential oversight agencies, such as: the Pokhara Municipal Office, the Shining Community Health Project, and the Kaski District Public Health Office. Replacement volunteers were not found and trained. Differences were found between service statistics and post-intervention survey results and were accounted for. Community health volunteers did not accurately record statistics on births, deaths, marriages, and migration. Females were more effective than males. Improvements were found in increases in prenatal care, immunization coverage, and use of oral rehydration. The deficiencies in the program were due to inadequate supervision, training, motivation, and follow-up.
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