Nepal’s community health workers advance in struggle for job security and recognition

Representatives of Nepal’s Female Community Health Volunteers joined trade union delegations at the annual ILO meeting to advocate for job security and recognition

June 12, 2024 by Peoples Health Dispatch
Source: USAID/Flickr

Community Health Workers (CHWs) from Nepal are advocating for job security, fair compensation, and recognition at the annual International Labor Organization (ILO) meeting. Basanti Maharjan and Gita Devi Thing, representing Female Community Health Volunteers, joined a Public Services International (PSI) delegation from June 3-14 to highlight their working conditions and the importance of recognizing CHWs as key contributors to the care sector.

In many Asian and African countries, thousands of CHWs provide crucial healthcare services to remote communities, including maternal and infant care and public health advice, such as during the COVID-19 pandemic. Despite their critical role, CHWs are often marginalized within the healthcare system and exploited to fill gaps left by underfunded public health systems.

Read more: Community health workers in South Asia forge joint struggle for rights and recognition

On the other hand, CHWs’ contributions are well recognized within their communities, as they are usually part of the territories they serve. In Nepal, the selection process for CHWs is community-driven, with active mothers’ groups choosing the workers. This strong community connection is highly beneficial for public health. To protect and nurture this link, PSI emphasizes the need for local, regional, and national governments to support CHWs and grant them equal rights to other workers in the health and care sectors.

However, the situation today is far from ideal. Different levels of government in Nepal have been pointing fingers at each other instead of engaging in productive discussions about the future of CHWs. Like in other South Asian countries, CHWs in Nepal face neglect, impacting their health and safety, especially during the COVID-19 pandemic when they performed essential public health tasks without adequate protection, including personal protective equipment.

In 2022/2023, Nepal’s 52,000 CHWs received an annual remuneration ranging from USD 96 to USD 384. “Despite making sacrifices and doing our work earnestly, we are not treated as workers but as volunteers,” said Gita Devi Thing. “This is unjust. We deserve dignity, respect, and fair compensation for the vital services we provide to our communities.”

Valuing CHWs to strengthen public health systems

PSI’s campaign for CHWs’ rights affirms that their tasks and realities fall under the umbrella of fundamental rights and principles at work. Thus, PSI is appealing to the ILO to recognize CHWs as part of the care workforce, pushing national governments to value them equally to other sector workers.

Valuing CHWs fairly would benefit public health systems and predominantly women workers performing public health tasks. Kate Lappin, PSI’s Asia Pacific Regional Secretary, recently highlighted the gender dimension of this issue, noting that CHWs are exploited largely because they are women. “Why do we expect women to accept minuscule honorarium payments for critical public health work? It’s because women’s care work is devalued and taken for granted,” she said.

Publicly recognizing the contribution of CHWs to the right to health would be a significant step forward for the ILO and national governments, stabilizing public health systems and rectifying a long-standing injustice. “We are not volunteers,” Thing emphasized during conference preparations. “We are workers.”

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