Improving skills and utilization of community health volunteers in Nepal.

The study analyses the effects of a Nutrition Education Intervention (NEI), specifically designed to reduce vitamin A deficiency, on skills and utilization of Community Health Volunteers (CHVs) in rural Nepal. The intervention, which included preventive and curative activities, was carried out through the existing Primary Health Care (PHC) structure, utilizing CHVs trained by the Ministry of Health and already working in the villages. At the end of two years implementation, the CHVs associated with the NEI showed an improved ability to detect and treat a range of common diseases (diarrhoea, night blindness, malnutrition and acute respiratory infections) as compared with the CHVs not associated with the intervention program. Community utilization of CHVs increased significantly while the use of traditional healers and consultations at private pharmacies decreased. The utilization of health posts and referral to hospitals remained constant. Coverage for all activities carried out by the CHVs was higher among the population within the NEI area. The intervention did not utilize cash incentives. Its operational input consisted mainly of more frequent training, added supervision and increased and regular drug supply. The inclusion of curative activities among the CHVs' responsibilities seems to be a key factor in increasing motivation of volunteers and their acceptance within the community. This study indicated some possible adjustments to improve productivity and utilization of health volunteers in rural communities of Nepal, with a positive return for all PHC activities.