Tupange Pamoja identification of and engagement with community health workers and village health teams has yielded positive results.

• CHWs/VHTs have been instrumental in referring clients for family planning services. In 2018/9, they referred 42,562 clients to TCI-supported sites as documented in the program monthly monitoring data. Of these, 72% were effective referrals.
• CHWs/VHTs distributed oral contraceptives to 29,815 clients between July 2018 and June 2019 (source: HMIS).
• CHWs/VHTs are now competent and actively involved in providing information and dispelling myths and misconceptions during community meetings and dialogue days, as well as in counselling sessions.
• CHWs/VHTs have been instrumental in mobilizing communities for services during in-reaches and outreach services.

For an effective family planning program, a selected number of CHWs/VHTs should be trained. This will depend on availability of resources and the intended coverage area. The following steps are key to effective family planning promotion by CHWs/VHTs:

Identify and train CHWs/VHTs

• • Recruit CHW/VHTs from beneficiary communities.
  • Provide supplemental training in family planning to CHWs/VHTs who have undergone Community Strategy training and are working closely with health facilities. Tupange Pamoja provides a 5-day training on family planning to equip CHWs/VHTs with adequate knowledge and skills to conduct community-based distribution of contraceptives.
  • Use Ministry of Health curriculum on Community Strategy (Kenya/Tanzania/Uganda) and WHO Guide to Family Planning for Community Health Workers and Their Clients.
  • Sensitize County Reproductive Health Coordinators, Community Health Coordinators and Community Health extension workers on community strategy so that they can support CHWs/VHTs to promote family planning at the community level. Define CHWs/VHTs’ roles in order to define areas of support to the health system

Equip CHWs/VHTs

• • • Provide CHWs/VHTs with referral slips for long term methods.
    • Equip CHWs/VHTs with tools to record and track information.
    • Link CHWs/VHTs to health facilities for commodities and supplies, expanding the variety of methods they are able to distribute. Success of CHW/VHT programs is directly linked to continuous product availability at the community level. The health facilities should provide the CHWs/VHTs with a commodity tracking tool to account for commodities distributed. Data from the commodity tracking tool should be fed into the health facility daily activity register.

Support and motivate CHWs/VHTs

• • Community Health Extension Workers should routinely oversee the activities of the CHWs/VHTs and hold monthly meetings to review the activities for the month and plans for the coming month and ensure compliance with standards of practice and the delivery of quality family planning services.
    • Conduct updates during the monthly meetings to keep the CHWs/VHTs abreast with updated family planning information and to dispel myths encountered during  promotion in the community.
  • County health staff should provide supportive supervision to the community level activities.
  • Motivate CHWs:
    • Offer lunch and transport during meetings, mobilization, inreaches, and outreaches. Recognize the best performing CHWs/VHTs during meetings, issue certificates after completion of training
    • Provide CHWs/VHTs with promotional materials and supplies to support their efforts. These include shirts, bags, caps, umbrella, IEC materials, gumboots, umbrellas, T-shirts

Monitor the work of CHWs/VHTs

• Use data for continuous improvement based on information from a variety of sources (e.g. routine monitoring, field visits) and address performance issues to respond to the needs of the community.
• Compile supervision reports and submit to MoH reporting tools.

• Recruit men as CHWs/VHTs to increase the potential of reaching men with FP services
• Engage CHWs/VHTs during mobilization for outreaches and in reaches
• Create community demand for FP services and ensure availability of commodities and supplies
• Provide branded materials to the CHWs/VHTs to make them stand out in the community

The efforts of CHWs/VHTs in promoting family planning should be monitored on a regular basis. Monitoring of the activities of CHWs/VHTs takes place through monthly meetings and supportive supervision by the CHWs/VHTs. The following tools have been used to collect monitoring data:

• Community-based distribution: Monitored through Community Health Extension Worker (CHEW) summary, generated from the commodity tracking tool on monthly basis.
• Monthly meeting: Tracking referrals, number of clients reached, active and inactive CHWs/VHTs, sharing of experience and addressing challenges by sub-county team.
• Supportive supervision: The CHEWs provide routine monitoring of CHW/VHT activities at the community level through supportive supervision routinely, while the sub-county supervise community activities on a quarterly basis.
• Documentation of CHW/VHT efforts through CHW/VHT service delivery log tool, where CHWs/VHTs record daily service activities at the household level
• Tracking the number of women of reproductive age at household level routinely, through household register

The efforts of the CHWs/VHTs are measured through the following indicators:

• Number and percentage of clients reached through Community-Based Distribution
• Number and percentage of CHWs/VHTs reporting each month
• Number of community members referred for contraceptive methods each month
• % of effective referrals by CHWs/VHTs

• Training costs: training materials, certificates, stationery; lunch and transport for CHWs/VHTs for 5 days; facilitation fees; facilitators’ lunch and transport; snacks, training venue
• Promotional materials (branding purpose): caps, t-shirts, wraps, pens, key holders
• Working tools: Gumboots, bicycles, bags, umbrellas, penile model.
• Printing of data collection and reporting tools
• Monthly meetings cost: MoH staff, CHWs/VHTs, snacks, venue, transport and lunch
• Supervision cost: MoH staff – lunch and transport, supervision materials
• Mobilization costs: snacks, lunch, water, Megaphones

• Incorporate community family planning activities in the MoH Annual Working Plans that include monthly meeting continuous updates at the facilities
• Equip Community Health Assistants with adequate information to be able to train and supervise CHWs/VHTs on family planning
• Work within existing MoH/community structures
• Strengthen linkage of CHWs with health facilities for supervision and provision of family planning commodities
• Ensure that community data is incorporated in the Daily Activity Register and the District Health Information System (DHIS)
• Advocate for resources and budget allocation to support training and materials for CHWs as they promote family planning from the geography government