Adult Learning Program is an innovative health communication approach for improving community health being implemented in Rasuwa district of Nepal. UNICEF/Nepal and Family Health Division partnered with IRHDTC for the implementation of “Capacity Development of FCHV using Adult Learning Techniques” aimed at strengthening the Female Community Health Volunteer program to improve maternal and child health and enhance community involvement in primary health care.The approach is based on the social cognitive theory of health promotion. The program utilizes blend of drama and BCC approach to communicate health messages in mothers’ group– health. The program is aimed at empowering and developing capacity of the FCHV for the promotion of health and healthy behaviors of the mothers and community people with focus on poor and socially excluded. The objective of the program is to strengthening the capacity of FCHV to communicate effectively in groups using drama approach, counsel using Interpersonal Communication (IPC) skills, identify the community problems through Participatory Rural Appraisal (PRA) techniques and mobilize the mothers’ group– health and community people.

INTRODUCTION

Adult Learning Program (ALP) was envisaged by UNICEF and IRHDTC which was further developed and refined after several rounds of consultative meetings among UNICEF, IRHDTC and FHD. FHD team played significant role in selecting the district, setting up favorable piloting environment at central and district level and actively involved in all the activities of the pilot program throughout the program.

IMPLEMENTATION

After the completion of the baseline survey and development of training manuals, IRHDTC conducted MToT training to 17 active FCHVs from 17 VDCs of Rasuwa District.The 5 days community level FCHV training commenced from 27 February, 2012 in which the team of 3 MToT FCHV provided trainings to their colleagues. All health workers were involved in the FCHV training on 4th and 5th days to provide them basic orientation about the program. A three member support team comprising of 3 best performing FCHV in the community level training was formed in each VDCs for supporting the fellow FCHVs to conduct drama based mothers’ group– health activities after training. Besides this, IRHDTC field and central staffs provided intensive monitoring of FCHV and mothers’ group activities. The IRHDTC and DHO staffs regularly provided technical support visits to various health facilities and mothers’ group– health jointly till August, 2012. The endline survey including small scale qualitative study was conducted in August 2012 for assessing the impact of the program.

FINDINGS

The endline survey and qualitative exploration have indicated that the Adult Learning Program has been able to achieve its objective of making mothers more knowledgeable on key health issues. In the study, the endline information were compared with the baseline information on the status of communication ability of FCHV as well as the situation of KAP of mothers with under 5 children before and after the intervention.

CHALLENGES

Every innovative and pilot endeavor has challenges for effective implementation of the program. One of the key challenges felt by during the program was that not all FCHV have developed same level of competency in conducting drama based mother’s group– health meeting. In some case, mothers group– health meetings were not regularly held especially in the upper region of Rasuwa. Due to the limited financial and human resource of District Health Office, ensuring regular monitoring and supervision, refreshers training and other support are also some of the key challenges.

CONCLUSION AND RECOMMENDATION

To conclude, the program have shown positive effects in promoting health of the mother and child. In remote districts like Rasuwa, the program has potentiality to raise awareness through “drama” where there is lack of health awareness and potentiality of strong community mobilization. DHO, FHD, UNICEF and IRHDTC was committed in the effective implementation of the pilot program and contribute in the improvement of maternal and child health through strengthening mothers’ group– health activities and introducing innovative activities such as FCHV to FCHV training approach, PRA, peer based monitoring and support mechanism. It is highly recommended that government scale up such innovative health communication program. Another way may be to integrate major approaches of the program (drama, PRA) into the existing FCHV basic training manuals and other related programs. The learning from the program will definitely help to further strengthen the FCHV program and its aim of improving maternal and child health. ..