Working with Community Health Volunteers/Workers and Village Health Teams to Promote Family Planning

TCI’s identification of and engagement with CHPs/CHWs/VHTs has yielded positive results, increasing the uptake of FP methods.

• In India, women living in communities where CHWs supported a behavior change communication campaign focused on healthy timing and spacing of pregnancy were 3.5 times more likely to be using modern contraception at 9 months postpartum than women living in communities where CHWs were not involved in this communication campaign
  Sebastian, M. P., Khan, M. E., Kumari, K., & Idnani, R. (2012). Increasing postpartum contraception in rural India: evaluation of a community-based behavior change communication intervention. International perspectives on sexual and reproductive health, 68-77.
• An analysis of DHS data found that in areas where CHWs are engaged on mobilization and referrals have higher impact than the national average
  Tawye, Y., Jotie, F., Shigu, T., Ngom, P., & Maggwa, N. (2005). The potential impact of community-based distribution programmes on contraceptive uptake in resource-poor settings: evidence from Ethiopia. African journal of reproductive health, 15-26.
• Integrating CHWs into the health system is one of several proven “high-impact practices in family planning” (HIPs) identified by a technical advisory group of international experts. A proven practice has sufficient evidence to recommend widespread implementation as part of a comprehensive family planning strategy, provided that there is monitoring of coverage, quality, and cost as well as implementation research to strengthen impact
  High-Impact Practices in Family Planning (HIPs). (2015). Community health workers: bringing family planning services to where people live and work.
• There is substantial evidence on the efficacy and effectiveness of community health worker (CHW) programmes in low- and middle-income settings
  (Lewin et al., 2005; Starfield et al., 2005; Black et al., 2017; Scott et al., 2018)
• CHWs serve as the first point of contact for Rwandans seeking FP services—and they connect people with the next tier of health care provider for continued care of the client’s needs
  Ministry of Health, Rwanda. National Community Health Policy. 2015

Selection criteria for the CHPs/CHWs/VHTs

• The selection criteria may include demographic elements, such as gender, age, marital status, and usual place of residence, as well as education level and ability to successfully complete training on standard competencies, which will be heavily dependent on the specific community-based health strategy that the CHWs will support, as well as the roles and responsibilities they will undertake.
  TIP: Refer to specific country Ministry of Health (MOH) guidelines on CHPs/CHWs/VHTs selection criteria and formation of functional community units
• Residency is more often an important criterion in the selection of CHWs; recruiting CHWs from within the communities that they serve is considered a best practice.
• Involve and consult communities in the selection process and on the final selection of the CHW, as she or he needs to be welcome to serve in their community

Training and Equipping for CHPs/CHWs/VHTs

• Training CHPs/CHWs/VHTs in community-based FP using country-specific guidelines and training packages/manuals. 
• Supplemental training/orientation in FP and contraception services to CHPs/CHWs/VHTs who have undergone Community Strategy training and are working closely with health facilities, Gender sensitization topics and PPFP package should be inclusive during the training.
• Equip CHPs/CHWs/VHTs - Provide CHPs/CHWs/VHTs with continuous community tools and commodities for successful programming at the community
• The relevant tools and resources will facilitate FP service delivery and promotion at the community level these include; the counselling flip charts, contraceptive methods, Provide them with relevant information, education, and communication (IEC) materials, Reporting tools, Identification materials (branding) and support materials (Gum boots, Umbrella, counselling bags, Backpacks, T-shirts, Leso)
• Link CHPs/CHWs/VHTs to the nearest health facility for commodities, supplies to strengthen community-based distribution of FP methods and counseling, and referrals for services beyond their scope; LARC clients, and client mobilization during specific community
• Sensitize the reproductive health coordinators, community health assistants (CHAs)/community health-based service coordinators on the country community strategy so that they can support CHPs/CHWs/VHTs to promote FP at the community level

Engagement of the CHPs/CHWs/VHTs 

The community health workers could be engaged in;

• Community dialogues
• Mobilization during reaches and outreaches
• Distribution of FP commodities at community level
• Provision of FP information and counselling at the community level
• Referral and linkages of clients for FP services
• Advocacy with gate-keepers/community leaders

Documentation and reporting of community efforts

Consider using MoH reporting guidelines, and tools. The reporting should include; community referrals and services offered.

Three discreet roles of CHPs/CHWs/VHTs’ to define areas of support to the health system.

Tips:

Support and motivate CHPs/CHWs/VHTs

• Routinely supervise the activities of the CHPs/CHWs/VHTs and hold monthly meetings to review the data and activities for the month, plan for the coming month and ensure compliance with standards of practice and the delivery of quality FP
• The facility in charge should join the CHPs/CHWs/VHTs data review meeting to ensure that commodities are accounted for, to offer updates on FP/AYSRH, and get feedback from the community.
• Conduct updates during the monthly meetings to keep the CHPs/CHWs/VHTs abreast of updated FP information and to dispel myths encountered during community Facility health staff should provide supportive supervision to the community-level activities.
• Ensuring supervision of CHPs/CHWs/VHTs to ensure the provision of quality FP services in the community.

 Monitor the work of CHVs/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
• Compile supervision reports and submit to MOH through HMIS

 
• Recruit men and young champions or satisfied users as CHPs/CHWs/VHTs to increase the potential of reaching men and youth for reproductive health
• Successful CHPs/CHW/VHT programs are directly linked to continuous commodity availability at the community
• Consider providing monthly stipend/allowance for motivation

The efforts of CHPs/CHWs/VHTs in promoting FP should be monitored regularly. Monitoring of the activities of CHPs/CHWs/VHTs takes place through monthly meetings and supportive supervision.

The following tools have been used to collect monitoring data:

• Community-based distribution: Monitored through community health Staff, generated from the commodity tracking tool every month.
• Monthly meetings: Tracking referrals, number of clients reached, active and inactive CHPs/CHWs/VHTs, sharing of experiences, and addressing challenges with the health team.
• Supportive supervision: The CHAs/CHBSCs provide routine monitoring of CHP/CHW/VHT activities at the community level through supportive supervision routinely and monthly/quarterly meetings, while the sub-county supervises community activities every quarter.
• Documentation of CHPs/CHW/VHT efforts through CHP/CHW/VHT service delivery log tool, where CHPs/CHWs/VHTs record daily service activities at the household level, tracking the number of women of reproductive age at the household through a household register.

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

 
• Increase sustained demand for FP at community level
• Increased access to FP services at community and facility level
• 60% of referrals being effective referrals by CHPs/CHWs/VHTs

 
• Training costs
• Promotional materials (branding purpose)
• Printing of data collection, referral tools, and reporting tools
• Review meetings cost
• Supervision cost

• Work within local governments' existing community health structures and systems
• Offer monthly stipends/allowances within the government structures
• Resources and budget allocation to CHP/CHW/VHT within government structures