What is it about?

Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- income countries (including Nepal), members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). These FVHVs are a unique group of trained health volunteers delivering key health messages in their own communities. To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions. A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups such as Dalits, Madhesi, Muslim, Chepang and Tamang. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres.

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Why is it important?

Community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups. Moreover, such programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the Female Community Health Volunteers and paid local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in a low-income country like Nepal.


Community health volunteers in Nepal and community health workers in many other countries are an important resource for the poorest people in society. They need proper communication skills training to improve the uptake of available health services

Professor Edwin R van Teijlingen
Bournemouth University

Read the Original

This page is a summary of: Perceived barriers to accessing Female Community Health Volunteers’ (FCHV) services among ethnic minority women in Nepal: A qualitative study, PLoS ONE, June 2019, PLOS, DOI: 10.1371/journal.pone.0217070.
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