Perceived barriers to accessing Female Community Health Volunteers' (FCHV) services among ethnic minority women in Nepal: A qualitative study

• Published in: PloS one 2019-06, Vol.14 (6), p.e0217070-e0217070
• Main Authors: Panday, Sarita, Bissell, Paul, Teijlingen, Edwin van, Simkhada, Padam
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analysis; Child health; Children; Childrens health; Communities; Community; Community health aides; Culture; Decision Making; Ethnic factors; Ethnic Groups - psychology; Ethnic Groups - statistics & numerical data; Faith healing; Family; Family planning; Female; Geographical locations; Health care; Health care facilities; Health care industry; Health Knowledge, Attitudes, Practice; Health Services Accessibility - statistics & numerical data; Humans; Hybrid vehicles; Income; Interviews as Topic; Maternal & child health; Medical personnel; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Minorities; Minority & ethnic groups; Minority Groups - psychology; Minority Groups - statistics & numerical data; National health insurance; Nepal; Occupational health; People and Places; Practice; Pregnancy; Public health; Qualitative Research; Reproductive health; Rural areas; Social Sciences; Studies; Tropical diseases; Trustworthiness; Volunteers; Women; Women's health; Women's Health - statistics & numerical data; Womens health; Workers
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0217070

Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- and -middle income countries, members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions. A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups such as Dalits, Madhesi, Muslim, Chepang and Tamang. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres. We conclude that community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups, and the programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the FCHVs and local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in low- and -middle income countries.