Exploring the Role of FCHVs in Trauma Case Management in Nepal: A Qualitative Study

Traumatic injuries are a major cause of morbidity and mortality worldwide, with disproportionate burden in low-and-middle income countries. Nepal is no exception. Achham, a rural district in Nepal, suffers from a high prevalence of traumatic injuries primarily due to falls and road traffic incidents. Female Community Health Volunteers (FCHVs) might serve as essential frontline health providers to mitigate delay in care in rural regions. This study explores the feasibility of integrating FCHVs into the pre-hospital trauma care system in Achham, Nepal.

A qualitative approach using phone-based key informant interviews with 20 randomly selected FCHVs and five purposively selected health coordinators from different municipalities across the Achham district was conducted. Data analysis involved thematic coding using NVivo software to identify key themes related to FCHVs' interest, availability, authority, potential barriers and opportunity in their participation in pre-hospital trauma care.  RESULTS: FCHVs demonstrated high availability (flexible schedules, willingness to respond to emergencies) and motivation. However, a significant knowledge gap exists (90% unfamiliar with first response in trauma) and existing first-response training was limited (25%). Health authorities from all represented municipalities showed support for FCHV training and mobilization efforts in pre-hospital trauma care.  CONCLUSIONS: FCHVs possess the potential to contribute to pre-hospital trauma care, but require thoughtful program development that includes training and supervision. This study highlights the initial feasibility, motivation from participants and leaders for FCHVs integration in rural trauma care, paving the way for improved trauma care access in rural Nepal.