Community Health Workers
What are Community Health Workers?
Volunteers or paid employees that bring health information and services to people where they live and work, rather than requiring clients to visit a facility. Community health workers (CHWs) are an important cadre of workers in a health system. Personal contact with such a well-informed community member can help alleviate women’s and men’s fears about family planning, present contraceptive method options for spacing or limiting births, and facilitate access to family planning and other related services, such as maternal, neonatal and child health services, in both the government and private sector.
Using CHWs is a globally recognized effective approach to increasing uptake of family planning. When trained and provided with the necessary tools and resources, CHWs can help fill gaps in both demand generation and service delivery.* These community-based activities can take place at the home, at work, or other spaces where people gather, such as marketplaces, mosques or churches, and community meetings and celebrations.
*Most CHWs are allowed to provide non-clinical contraceptive methods - condoms, pills, fertility awareness methods.Many countries also allow CHWs to give injectable contraceptives, and some are even moving toward allowing them to give implants.You should check with your country's family planning service delivery guidelines to see who is allowed to provide different methods.
What Are the Benefits?
CHWs are trusted community members with the knowledge and understanding of their communities’ unmet needs for health and family planning.
They are often recognized and mandated by the Ministry of Health to provide health services.
CHWs can contribute to reduced waiting times at facilities if a woman can get her preferred method from a CHW (usually pills or condoms, and sometimes injectables or implants).
Task sharing selected family planning interventions to CHWs, such as counseling, can relieve the workload of higher-level providers, allowing them to focus on quality provision of provider-dependent methods such as the intrauterine device (IUD) or sterilization.
When linked to health facilities, CHWs can refer clients for contraceptive methods that they themselves cannot provide.
CHWs can provide follow-up care, for example, home visits after delivery.
How to Implement?
The decision to use CHWs and a community outreach strategy should not be taken lightly. While extremely effective, it is a major undertaking that takes careful planning, initial and refresher trainings to keep CHWs’ knowledge and skills up to date, ongoing supervision that is supportive and effective, and continuous monitoring for adjustments.
The following are general guidelines for TCI geographies to follow, but understand that there are many models for using CHWs in family planning that have been found to be successful.
Identify Existing CHWs Who Can Provide Family Planning Information and Services
Existing CHWs have established relationships with the communities they serve, with an understanding of how they fit into the overarching health system, and have received at least some training in health care.
Working with existing CHWs also relieves the burden of recruiting and selecting new CHWs, which can take considerable time and thought. New CHWs may also need approval by the government, another time-intensive process.
Finally, CHWs are likely already linked to a health facility, a national or regional health worker program, or an NGO. You can partner with these institutions to enhance your program as well as draw upon their resources and technical expertise.
Determine What Responsibilities to Give CHWs
Determine the specific tasks CHWs will perform based on local needs and national guidelines. Tasks often include:
- Conducting home visits to provide family planning information.
- Counseling and referring clients to health facilities.
- Distributing non-clinical methods (condoms, pills).
- Following up with clients to ensure continued use and manage side effects.
Train the CHWs
Training should be comprehensive and include both technical knowledge and interpersonal communication skills. Key topics include:
- Family planning methods and their mechanisms.
- Counseling techniques and addressing myths/misconceptions.
- Proper record-keeping and referral processes.
- Hands-on practice or role-playing scenarios.
Offer Supportive Supervision
Regular, supportive supervision is critical for maintaining quality and motivation. Supervision should focus on:
- Observing CHW interactions with clients to provide constructive feedback.
- Reviewing records and reports for accuracy.
- Problem-solving challenges faced in the field.
- Ensuring CHWs have the necessary supplies and motivation.
Provide CHWs with Adequate Equipment and Supplies
CHWs need the right tools to be effective. This includes:
- Counseling kits and visual aids (flipcharts, method samples).
- Referral slips and reporting forms.
- Identification (badges or branded clothing) to build trust in the community.
- A reliable supply of contraceptives if they are authorized to distribute them.
Consider Using CHWs Creatively for Demand Generation Activities
Beyond one-on-one visits, CHWs can support broader demand generation by:
- Organizing community dialogue days or group orientations.
- Partnering with local leaders (religious or civic) to advocate for family planning.
- Using digital tools or mobile phones for client follow-up and reminders.
External Resources
- USAID Global Health eLearning Center course on Community-based Family Planning
- USAID Global Health eLearning Center course on Family Planning Counseling
- K4Health Toolkit on Community-based Family Planning
- Reference Guide for Program Managers and Policy Makers on Developing and Strengthening Community Health Worker Programs at Scale
- Catalogue of Community Health Systems in 25 countries, providing information on what services are delivered at the community level and who delivers them
- Advancing Partners & Communities project website has numerous resources and success stories of community-based FP and community health systems
- FP HIPs Brief on Community Health Workers
What Is the Evidence?
The use of CHWs for family planning counseling and provision of methods increases contraceptive use. For a comprehensive yet succinct analysis of the evidence, see the High Impact Practices in Family Planning brief on CHWs.
Allowing CHWs to provide condoms and oral contraceptives allows facility-based service providers more time to provide quality care in the facilities.
In 2018 and 2019, CHWs and VHTs in East Africa referred over 42,000 clients for family planning services, with a 72% completion rate. They also distributed oral contraceptives to 29,815 clients in that same time period.
As of November 2019, TCI in India reached 6,679 ASHAs with coaching support across its three supported states. ASHAs have become even more critical during COVID-19 lockdowns in reaching potential and existing FP clients with pills and condoms.
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