Answer the following questions to assist you in identifying the appropriate role and responsibilities for CHWs.

• What is the highest level of education they have attained? Are they literate?
• What training have they received?
• Who is supervising them? To whom do they report?
• Who else is on their health team (if there is one)?
• What tasks are they already expected to carry out?
• Are they expected to keep records and follow up with clients/community members?
• Are they paid or unpaid/volunteers?
• If volunteers, what motivates them to do their work?
• Do they have resources to travel? From whom do they get the resources?

This resource from the Maternal and Child Health Integrated Program describes comprehensively the considerations program planners need to make when determining the roles and tasks of CHWs.

CHWs can take on a variety of family planning responsibilities depending on their level of education and training. After considering the answers to the questions posed in Step 2, you should decide whether CHWs will:

• Provide contraceptive methods in addition to counseling, and if so, which methods
• Provide counseling only, and referrals for provision of methods
• Conduct awareness-raising activities around family planning and its benefits

These decisions may depend on your country’s laws and policies.

For an example of CHW responsibilities, see the terms of reference developed for NURHI social mobilizers.

Your national Ministry of Health will likely have training materials for CHWs based on your country’s laws and policies. If not, the following globally accepted guidelines and materials can be adapted for your context.

The Training Resource Package for Family Planning, a comprehensive website supported by the World Health Organization (WHO), the United Nations Population Fund (UNFPA), and the United States Agency for International Development (USAID), offers curriculum components and tools for trainers to design, implement, and evaluate family planning and reproductive health training workshops. All materials can be downloaded for free, and you may adapt or translate them for your own work.

K4Health Toolkits are practical collections of trusted global health resources, chosen by experts and arranged for easy use. The Contraceptive Methods collection, specifically, includes toolkits on most methods, including pills, condoms, injectables, implants, the IUD, permanent methods, and more, with method-specific materials for training, program management, service delivery, and health communication. The Toolkits include links to resources in multiple languages and country-specific information when available.

The Global Health eLearning Center, supported by USAID, provides many self-paced Internet-based courses that are easily accessible to the entire international health community. Some courses are in French. We recommend starting with the courses under the Family Planning Methods and Family Planning Programming topics.

To learn how Tupange developed a CHW program that followed national guidelines and also served program needs, see the East Africa Toolkit.

Benefits of Strong Linkages Between CHWs and Facilities:

 

 

 

• CHWs may be the only link that a community member has with the facility.
• Referrals of clients from CHWs can be strengthened if facility providers recognize and appreciate the work of the CHWs.
• CHWs can perform outreach to community members and mobilize them for facility-based services.

Make sure CHWs are operating within a system that will support and guide them in their responsibilities. For example, supervisors should routinely oversee the activities of the CHWs and hold monthly meetings to provide feedback. Monthly meetings can also serve as a way to provide family planning updates to CHWs and discuss myths and misconceptions encountered in the community. Periodic group meetings where all CHWs in a specific area attend can serve as a forum for CHWs to discuss common challenges and brainstorm solutions as a group. They can also be used to recognize high-performing CHWs and distribute certificates. The Tupange project completed a monthly performance evaluation form to provide supportive supervision to CHWs, which you can adapt for your context.

To do their work effectively, CHWs will need different equipment and supplies based on their responsibilities. For example, to facilitate counseling, CHWs can use a flip chart produced by WHO in multiple languages specifically designed for CHWs and their clients. If CHWs refer clients to facilities for contraceptive methods, such as long-acting methods, they will need a supply of referral slips (example of a referral card). To conduct community mobilization and dispel myths and misconceptions among community members, CHWs will need appropriately designed promotional materials, such as posters, pamphlets, T-shirts, and bags (example of promotional materials for use by CHWs). For CHWs providing certain contraceptive methods, they will need a stock of those methods and a way to replenish them as needed. In addition, if they provide injectable contraceptives they may need a sharps disposal container, alcohol swabs and bandages or gauze.

CHWs can be trained to be facilitators of discussion groups among community members to further reinforce family planning information received from radio programs, TV dramas, theater performances, and other communication materials. CHWs can raise additional issues, answer questions and further educate community members in a safe space.

• In Kenya, the radio program Jongo Love provided discussion guides for all 24 episodes for listeners to continue discussing the topics raised in each episode.
• In Nigeria, the Nigerian Urban Reproductive Health Initiative (NURHI) produced a Facilitator’s Guide for discussion groups as well as a Radio Drama Discussion Guide for its program Second Chance.

CHWs can serve as mobilizers for community health service days.

• In Kenya, prior to in-reaches for long-acting and permanent methods (LAPMs), CHWs conducted publicity and promotional activities for the service day so that community members who wanted a LAPM could plan for it.
• In Senegal, on fixed free family planning service days (en français), community mobilizers helped to raise awareness of the date and location of the free family planning service and of the methods that would be available. They also provided initial counseling and information on the various methods available.

CHWs can make personal visits to homes or to workplaces.

• In Senegal, community mobilizers made house-to-house visits to sensitize people on the benefits of family planning and provide accurate information on the methods available at their nearest clinic. Using interpersonal communication skills, these mobilizers talked to women, husbands, mothers-in-law, youth and adolescents, and religious and community leaders to dispel any incorrect information and myths about family planning. They used a modified version of a provider-initiated family planning tool to identify women with unmet need for family planning and referred clients to the nearest health facility if women expressed a desire to use a modern method.

CHWs can help map urban slums to ensure these underserved areas are targeted by program activities.

• In India, CHWs used a tool to map urban slums. They then used this information to visit every home in the slums to offer information about contraceptive methods, provide short-acting methods (condoms or pills), counsel women about postpartum family planning, accompany women to health facility, and refer women to the nearest health facility or a fixed service day.