• 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.

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. They include a number of toolkits related to contraceptive methods, including pills, condoms, injectables, implants, the IUD, and permanent methods. 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 Pamoja developed a CHW program that followed national guidelines and also served program needs, see the East Africa Toolkit.

• 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. TCI coaches local governments to complete a monthly performance evaluation form during supportive supervision visits with CHWs, which you can adapt for your context.

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. For example, TCI developed a Facilitator’s Guide Training Community Leaders, Champions and Gatekeepers on Family Planning to be used as part of community dialogues.

CHWs can serve as mobilizers for community health service days.

• In East Africa and Nigeria, prior to in-reaches, CHWs and social mobilizers conduct publicity and promotional activities for the service day so that community members who want long-acting reversible contraceptives (LARCs) can plan for it.
• In Francophone West Africa and India, on special family planning service days (en français) and fixed day static service, community relays and ASHAs help to raise awareness of the date and location of the free family planning service and of the methods that would be available. They also provide initial counseling and information on the various methods available.
• ASHAs in India are also critical for the successful implementation of adolescent health days and male engagement strategies,

CHWs can make personal visits to homes or to workplaces.

• In India and Francophone West Africa, ASHA and community relays make 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 frontline health workers talk to women, husbands, mothers-in-law, youth and adolescents, and religious and community leaders to dispel any incorrect information and myths about family planning. In Francophone West Africa, the community relays use a modified version of a provider-initiated family planning tool to identify women with unmet need for family planning and refer clients to the nearest health facility if women express 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, TCI coaches ASHAs and ASHAs’ supervisors, Auxiliary Nurse Midwives, on how to systematically complete and use their urban health index register (UHIR) to prioritize household visits for FP counseling and use the logistics management system to restock short-term supplies like condoms and pills.
• In Francophone West Africa, TCI adapted India’s mapping and listing approach to its context and community relays play a critical role in conducting the mapping along with facility managers to identify women of reproductive age.