Female community health volunteers (FCHV)  are the backbone of Nepal’s health system, working as a bridge to increase community access to health services. FCHVs advocate for healthy behaviors among mothers and community members to promote safe motherhood, child health, family planning, and other community-based health promotion and service delivery (1). FCHVs used the complementary monitoring and supervision (CMS) approach to identify gaps in LF MDA coverage while conducting vitamin A distribution.

What is the Complementary Monitoring and Supervision (CMS) Approach?

• Sharing information on both health interventions with households.
• Verifying if family members received MDA during the LF campaign that was conducted a week prior to the vitamin A campaign.
• Reinforcing the importance of taking LF medications if they were missed.
• Referring individuals to a nearby health facility for LF medication (FCHVs could only offer vitamin A capsules during household visits).
• Recording and reporting those who did not accept LF MDA to the local health facility and/or to the Ward Community members.

CMS supports implementation of integrated campaigns at the municipal level in the context of the country’s transition to a decentralized health system. Various municipal sectors can be incorporated into CMS, including in Nepal, education, women and children’s health, agriculture, veterinary, and Ayurveda. A supplementary program is needed to reach people missed in scheduled campaigns, particularly during high-travel festival seasons. Following this study, it was recommended that a representative study accounting for Nepal’s diverse ethnic groups and geographic settings would provide more evidence to promote policy change.

(1) Nirmal Kandel, Jaya Lamichhane, “Female health volunteers of Nepal: the backbone of health care,” The Lancet 393, no. 10171 (February 2019): E19-E20, https://doi.org/10.1016/S0140-6736(19)30207-7