SMS tools empowering FCHVs in Nepal: Adapting to a new normal during COVID-19 lockdown

Authors: Min Baduwal, Project Officer; Nitin Nischal Bhandari, Program Head, Asia; Niraj Kumar Nakarmi, Project Manager, Nepal 

As frontline health workers in Nepal battle one of the world’s most severe outbreaks of COVID-19, technology-enabled community health work is now more important than ever. 

In partnership with the Ministry of Health and Population (MoHP), Medic has successfully scaled care coordination apps – powered by the Community Health Toolkit (CHT) – to more than 10,500 Female Community Health Volunteers (FCHVs) in Nepal. Among them, more than 2,700 FCHVs are now trained and equipped with SMS tools in Sudur Paschim Province.

FCHV skill-building to thrive with mHealth 

In 2017, in partnership with health officials in Kanchanpur district, Medic introduced the “Training of Trainers” (ToTs) capacity building model to train a cadre of individuals who serve as experts to coach and mentor others. In addition to ToTs, MoHP and Medic led a three-day mHealth training – the first of its kind in Nepal – where select FCHVs learned skills like writing text messages, viewing the mobile inbox, sending and formatting messages, and more. 

Prior to the training, most FCHVs had limited experience using mobile phones, including message creation and communication with patients. Overall, FCHVs were interested and invested in the training session, with 100% participation from FCHVs in the district. To date, the FCHVs involved continue to excel in care coordination on their mobile phones. 

Equipped to serve communities during the COVID-19 pandemic

As the country remains in lockdown due to the COVID-19 pandemic, mobile-based remote communication skills and care coordination have become a lifeline between FCHVs and patients. With these SMS-based tools, FCHVs are able to remotely administer health counseling, register pregnant women, communicate vital events and danger signs, receive timely antenatal and postnatal care reminders, ensure safe deliveries, and improve maternal and newborn health. FCHVs are then able to send important reports back to the health facility, ensuring health records are updated across the interconnected health system to achieve continuity of care.

For FCHVs serving their communities, mobile technology helps to mend the disruption in primary care caused by the pandemic. Without routine home visits, SMS tools offer a safe space to provide remote counseling support to expecting mothers – a pillar component of the compassionate care services provided by trusted FCHVs. 

In their own words: FCHVs using remote care to reach patients 

Gita Devi Chaudhary is an FCHV stationed at the health post in the Krishnapur municipality. Gita is grateful for the mobile training and opportunity to enhance her skills as a tech-savvy care provider. Prior to the 2017 training, Gita had little experience using a mobile device. Now, she’s confident in making phone calls, communicating with patients, and staying up-to-date with facility-level reporting. 

“The community provided me with an opportunity to serve as an FCHV,” she says. “Before the Medic training, I only knew how to receive incoming phone calls. Now, I can write the text, send a message, and call anybody. I am very happy with this tool because during the lockdown, I am able to call [patients] to inform them of the necessary service. I am really happy with this program.” 

Rajmati Rana, an FCHV serving alongside Gita, finds many benefits of the SMS tool, too. “The reminder messages make it easy to meet and counsel [patients] timely,” she says. “FCHVs were [trained] to write and send text messages, and this program really supports FCHVs in interacting with the technology and making them technology-friendly.”

Janu Thakurathi loves to use the SMS tool, and encourages fellow FCHVs in the Krishnapur municipality who are not active in the program to join. “Mobile health is supporting and facilitating to make our daily work easier,” she says. 

Keeping frontline health workers safe and equipped

As FCHVs risk their own health and safety to provide care during case spikes across Nepal, community members can help prevent the spread of COVID-19 by staying home and maintaining social distance. While daily and essential service providers do not have this option, mobile phones and SMS-based tools provide a vital, safe opportunity to maintain essential care provision in order to keep families and communities safe and well.