The experiences of female community health workers during COVID-19 and the influence of gender norms and values in Nepal: A qualitative study.

Female Community Health Volunteers (FCHVs) are close-to-community providers who voluntarily serve their communities in Nepal. Gaps exist in evidence regarding the challenges posed by shocks such as the pandemic, as well as the gendered experiences of FCHVs in the general context. This study aimed to explore the experiences and challenges faced by FCHVs during COVID-19 and the influence of gender norms and values. We conducted a qualitative study in two municipalities, Gulariya in Lumbini province and Chandragiri in Bagmati province, Nepal. A total of 22 interviews were conducted between December 2020 and January 2021 using topic guides. These included key informant interviews with purposively sampled health coordinators, health facility managers, and local mayors, as well as in-depth interviews with FCHVs. A thematic framework approach, incorporating a gender framework, was applied for data analysis. NVivo 11 Pro software was used to support the analysis. FCHVs faced significant challenges due to gender norms, family expectations, and insufficient support from the health system during COVID-19. Balancing dual responsibilities at home and work created further difficulties in their daily lives. Although FCHVs were from and embedded within their communities and gained trust over time, they experienced some unsupportive behaviours, particularly from men who were not receptive to their roles. Inadequate support, such as a lack of supervision and training on COVID-19, further undermined the confidence of FCHVs and affected their ability to provide services. Shortages of personal protective equipment, lack of financial incentives, and male-dominated leadership hindered gender-sensitive planning, exacerbating the challenges FCHVs faced during the crisis. FCHVs are vital to Nepal's health system, especially during crises like COVID-19. Addressing gender norms, providing tailored training, promoting inclusivity, and involving male volunteers are key policy priorities. Future efforts should focus on strengthening FCHVs' resilience and addressing societal gender challenges.