This time the government had organized follow up visits to houses whose children were unable to receive the vitamin and de-worming medication, like elsewhere in the country. Volunteers had reached door to door in order to ensure that every child were administered both drugs. Prior to this, such follow up visits were not organized during such campaigns in the district.
Despite the precaution, District Health Office suggests that few children still missed the de-worming tablets. As per the data, 11,600 children received vitamin A while 10, 800 children were given the de-worming tablets. But the actual number of children across the district is higher. District Education Office data shows that 17,000 children of the targeted age groups are enrolled in 137 child development centers and schools of Mugu.
Citing this apparent conflict in the data, some have criticized the program's success claims. Defending the claims, Pashuram Nepali, focal person of the program in Mugu stated that the confusion is due to the nature of the distribution of the vitamin and the tablets. "Our data is correct though some people are making it controversial. What they should understand is, Vitamin A and tablet is given to all the children up to five years of age while only vitamin A is given to those below one year age," he explained. Data of the office states that the number of children from one to five years of age is 10,800 and that of infants is 800.
Every time the government launches health campaigns, it relies heavily upon the female health volunteers at the local level. But it does very less for assuaging their concerns, FHVs claim. These volunteers claim that they face extreme troubles in the rural villages.
They are not sufficient in number to execute tasks that the government time and again assigns them to executive. They are overloaded with work and at times are bound to work overtime for meager stipends, they claim.
Adding to their woes is the absence of the public health officials in their respective offices at the village level. These health workers, auxiliary nurse midwifes (ANM), health assistants (HA), often are absent when the FHVs need them during the campaign. Despite being paid by the government for their services, FHVs claim that they rarely get assistance from these professionals when they need them to provide health services at the local level.
"We have to work like machines and despite that we don't succeed in providing services through the area we are supposed to serve," said Bijay Laxmi Malla. "Those who are fully employed by the government and paid substantially by the government do not care to provide services at the local level when required." Echoing the concerns of many like her, Malla said that due to the absence of government appointed health professionals at the local level, "all the burden of providing health services and working in health and awareness campaigns is shifted on the shoulders of the FHVs."
A woman health worker is generally assigned with tasks like providing assistance to women during child delivery, providing counseling to pregnant women, mothers, providing periodic medicines to children and women and the general public as part of the health campaigns organized by government, distributing iron tablets to pregnant women among others in her ward. Covering a ward means dealing with dozens of households depending on the population density of the community. "And that's not easy," Malla remarked.
The job gets tougher when the households are scattered. In the hilly regions, houses are not located near to each other. "We do not have transportation services here. By walking how many houses can you cover when people are scattered all over the mountains?" she complained. On Thursday, Malla provided vitamin A and de-worming tables to 85 households of Chain VDC-5. Despite working from morning to evening, she was not able to reach out to all the households she was supposed to. "Despite working through the day, I still could not reach to 250 houses of the village," Malla reported.
Health volunteers like Malla are provided nothing more than a simple cotton bag and medicines. According to Malla, it would be wonderful if she would also be equipped with a megaphone to make important announcements. "I could make my job far more effective if I had a megaphone. I could call all the villagers at a particular place for delivering the services more easily and faster," she said adding that the children of tenants in some areas are difficult to count and cover. "Those who own houses could still be marked but those who do not have house of their own are missed out sometimes," said Malla.
Urmila Malla, another health volunteer stated that the campaign would be more successful if the government could deploy more volunteers and pay them well for all their toils. "To make health campaigns effective, FHVs should be provided trainings, and equipped with tools such as the megaphones. Along with appointing sufficient numbers of FHVs on the basis of demographics, paying them accordingly is necessary for making health services effective."
Continuing further, she said that despite such ground realities, the government is relying on a volunteer to cover a ward fully even though the wards inhabitants are scattered over miles. She added that even though the campaigns is supposed to conclude in two days, it takes her four days to fully cover the whole area assigned to her. "But who notices such toils. I am still paid for only two days by the government."
District Health Office pointed to lack of resources for its inability for providing additional muscles to such campaigns across the district. "We understand that there are problems but we don't have adequate resources to address them," said Nepali adding that they are doing whatever is possible to make such campaigns effective. Starting from this campaign, FHVs are being paid Rs 400 per day for volunteering in the campaign. Prior to this they were paid half of it.
Along with such stipends, the FHVs are paid an annual stipend of Rs 4000 for buying dresses. However, Urmilla complained that the dress stipend is never provided to them on time while adding that the government has failed to encouragement to the FHVs working in remote areas, providing essential health services.
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