Small Ripples, Big Impact: Lessons from Nepal’s Female Community Health Volunteers

Recently, I had the privilege of participating in onsite data collection for the University of Tokyo and the Health Action and Research Organization. Our focus was on Nepal’s Female Community Health Volunteers (FCHVs)—the true pillars of the nation’s health system.

This experience took me back nearly a decade to my time as a medical student. During our first community posting in rural Nepal, I stayed with and closely followed the incredible work of FCHVs. Their dedication and selflessness left an indelible impression on me. Revisiting those roots through this project was both humbling and inspiring.

One question in our survey stood out:

"Do you think FCHVs deserve more incentives?"

Naturally, I assumed their response would be a resounding “Highly Agree,” considering they currently receive a mere NPR 400 (around USD 3). However, to my surprise, their unanimous response was “Highly Disagree.”

When asked why, these women explained that their work was not about money; it was about making a difference. Their self-motivation and commitment to the well-being of their communities moved me deeply. They shared how their work gave them a sense of purpose, respect, and recognition in their communities. For them, this was more than a health initiative—it was a form of women’s empowerment, a way to elevate their voices and create lasting positive change.

This experience reminded me of the power of small, meaningful contributions. Together, these small efforts create a cumulative impact that can transform communities.

Here’s to the FCHVs: unsung heroes of public health and to everyone making small ripples that lead to waves of change.