Feminist political economy analysis of labor rights and protections of Nepal’s community health workers

Community health workers are a feminized cadre often engaged informally with low pay and without labor law protections. Feminist political economy (FPE) argues that the undervaluation of health and care workers relates to gendered assumptions around skill and motivation. We examined the labor rights and protections of Nepal’s Female Community Health Volunteers (FCHVs) through an FPE lens to assess the valuation of their work by decision-makers and the opportunity costs of volunteering. Our case study design collected data from 165 documents, 26 semi-structured interviews and five focus groups from four districts in Bagmati province, analysed via thematic analysis using a two-pronged framework derived from the World Health Organization’s recommendations for CHW programs and health workforce labor rights: ‘remuneration fairness’ relative to cost of living, labor market and workload, and ‘social protection’ as insurance, retirement benefits and legal recognition. Remuneration was not considered ‘fair’ relative to living costs, labor market context or their workload, contributing to turnover among younger, higher-educated FCHVs. Social protection gaps persisted around health and life insurance, and retirement compensation was low relative to the longstanding experience of some FCHVs. Although informality impedes FCHVs’ labor rights, some municipalities have added incentives and expanded social protections, in part through female Deputy Mayors and FCHVs elected into local government. Gendered assumptions around time availability and skill persist among policymakers, contributing to the low valuation of FCHV labor. • Community health workers face occupational hazards but lack labor protections • We analyzed labor rights of Nepal’s Female Community Health Volunteers (FCHVs) • Remuneration did not cover expenses, workload; insurance and retirement gaps found • Under federalism, some municipalities have expanded FCHV labor rights • Gendered assumptions around women’s time availability and skill impede rights