Evaluating the long-term impact of Female Community Health Volunteer involvement in a postpartum family planning intervention in Nepal: a mixed-method study at 1 year post-intervention

Abstract Background This is a 1-year post-intervention study following an initiative to provide orientation to female community health volunteers (FCHVs) on postpartum family planning (PPFP) in Nepal implemented in December 2018. Despite positive results in the earlier post-intervention study, this study was designed to provide a more long-term perspective on sustainability by assessing the effect at 1-year post-intervention. Methods This mixed-methods study was conducted in January 2020 in Morang district, Nepal. We collected quantitative data from a knowledge assessment of FCHVs who had participated in the intervention on PPFP; data on their community-based counseling coverage and through interviews with postpartum mothers in two selected hospitals. Qualitative data was collected through six key informant interviews with health providers working on PPFP and four focus group discussions with FCHVs involved in the intervention. We performed descriptive and multivariable analyses for quantitative data and thematic analysis for qualitative data. Results of 1-year post-intervention were compared with pre-intervention and earlier evaluation study results. Results In total, 206 FCHVs participated in the 1-year post-intervention knowledge assessment with a 15-fold [adjusted odds ratio (AOR) = 14.9, p < 0.001] increase in knowledge when compared with the pre-intervention phase. A 20-fold increase in knowledge (AOR = 20.4, P < 0.001) had been reported in the post-test conducted immediately after the orientation. The FCHVs counseled 71% of the pregnant women within their communities at 1-year post-intervention. The postpartum mothers in hospitals had 2 times higher odds than in pre-intervention phase of being counseled by FCHVs during their pregnancy at 1-year post-intervention (AOR = 1.9, P = 0.036) as compared to a 3-fold higher odds of being counseled at 2-months post-intervention (AOR = 2.9, P < 0.001). The qualitative findings suggested a positive impression regarding the FCHV's involvement in PPFP counseling in the communities, however, supervision and monitoring over the longer term was identified as a key challenge and may influence sustainability of community-based and hospital-based PPFP services. Conclusion The FCHVs’ knowledge and community-based activities on PPFP remained higher than in the pre-intervention phase. They had however declined when compared to the 2-months post-intervention period. We propose regular supervision and monitoring of the work of the FCHVs in order to sustain progress.