Heroes of remote Nepal: Women leading the way to healthier communities

Women in Nepal have become promising agents of change, improving control of type 2 diabetes and social trust. Now, a scale-up to rural areas is expanding the role of female community health volunteers in strengthening a vulnerable health system. 

Although the pilot ended in 2022, it has been five years since WDF’s last visit to Nepal; pandemic restrictions and difficult road access made it difficult to travel. And while it may be a unique experience, navigating deep valleys, towering peaks, and incredibly steep mountains is no easy endeavour.

However, this spring, WDF’s programme manager Marianne Kjærtinge Faarbæk was able to travel to Nepal and meet the local stakeholders: our partners, provincial and federal health authorities, FCHVs like Debaka, and community members living with diabetes.

It was an opportunity to see encouraging results: the FCHVs and health staff trained under the pilot continue to provide diabetes and hypertension screening and management and lifestyle counselling, even after the pilot's completion two years ago.  

‘These services have moved closer to the communities they serve and have had a profound effect on the quality of life of people living with diabetes and hypertension’, remarks Marianne.

Moreover, a second project phase, Community-based diabetes and hypertension prevention and care (WDF20-1780), began this spring. While the pilot covered urban and semi-urban areas of the Gandaki province, the scale-up is expanding to rural areas.

According to a recent government study, 20% of the Nepali population lives below the poverty line. The poverty rate has remained high due to the numerous changes in the past ten years, from political instability, prolonged electricity supply issues and earthquakes to facing the COVID pandemic. 

Equally important, with a new constitution and federalisation process, Nepal's healthcare has been decentralised to improve the delivery of and access to basic health services: the government handles policy, regulatory frameworks, and specialised healthcare, while municipalities manage primary care. Despite making healthcare more equitable and locally responsive, the process struggles with infrastructure, staff shortages, and procurement delays. Additionally, not all municipalities are covered by the government insurance scheme.

A major component of the new scale-up aims to support this process by extending screening and management services, including nutrition and healthy lifestyle counselling, to the local level, ensuring linkages to primary care facilities as well as advanced care for people with diabetes, hypertension and related non-communicable diseases (NCDs).