Maternal, Newborn, and Child Health
MNCH Health Systems Strengthening Interventions
Maternal, Newborn, and Child Health
MNCH Health Systems Strengthening InterventionsCommunity Health Workers
A Critical Link for Strengthening MNCH Services
Community Health Workers (CHWs) are increasingly recognized as essential contributors to resilient and equitable health systems, especially in resource-constrained settings. Their close connection to the communities they serve uniquely positions them to bridge the gap between formal health services and underserved populations. In the context of maternal, newborn, and child health (MNCH), CHWs play a transformative role – bringing care closer to families, improving access to critical services, and fostering trust in the health system.
Effective MNCH programs depend not only on strong facilities and trained providers but also on meaningful community engagement. A bottom-up approach that fully integrates CHWs into national and subnational health systems is essential. This integration empowers communities to take an active role in their own health, strengthens primary healthcare, and enhances the scale, reach, and sustainability of interventions.
CHWs are typically members of the communities they serve, which allows them to understand local needs, customs, and barriers to care. They support the health system by delivering services directly at the community level – educating families, conducting home visits, providing referrals, tracking pregnancies, and promoting facility-based deliveries and skilled birth attendance. These efforts are key to reducing maternal and neonatal mortality, improving early childhood health, and advancing health equity.
By reinforcing the continuum of care from the household to the health facility, CHWs not only extend the reach of the health system but also contribute to its overall effectiveness and resilience. Their role in health promotion, disease prevention, and linkage to care makes them indispensable in efforts to improve MNCH outcomes and build stronger, more inclusive health systems.
What Are the Benefits of Community Health Workers?
CHWs play critical roles within the health system as first responders and complementary healthcare delivery agents, extending services beyond facilities through home visits and various interventions. CHWs collaborate with frontline workers to provide education, distribute resources, manage illnesses, and facilitate referrals. These interventions aim to bring healthcare directly to communities and empower them in managing their own health.
Community health workers help to:
How to Implement
1. Select Community Health Workers
- Identify and recruit CHWs using established selection criteria.
- Consider demographic factors such as gender, age, marital status, residence, and education level.
- Prioritize recruiting CHWs from within the communities they will serve – residency is a key best practice.
- Involve community members in the selection process to ensure the CHW is welcomed and accepted by the community.
- Base qualifications should align with the community-based health strategy and roles the CHW will be expected to perform.
2. Align CHW Mandates with National Policies
- Review existing national policies and community health strategies to determine which services CHWs are authorized to deliver.
- Where feasible, adopt task-shifting approaches to expand CHWs’ roles – including administering uterotonics, performing basic neonatal resuscitation, or providing IV antibiotics in specific settings – while ensuring they receive the necessary training and supervision.
3. Map and Cluster CHWs into Support Groups
- Organize CHWs into functional groups or clusters to enhance collaboration, shared learning, and problem-solving.
- Engage them in participatory group activities such as women’s groups that identify and address maternal and newborn health challenges. These groups support care-seeking behaviors and improve community-level outcomes.
Example: Pakistan’s Lady Health Workers (LHWs) function as an organized national network of female community-based health workers.
4. Train, Retrain, and Support CHWs
- Provide CHWs with competency-based training using national or WHO-approved MNCH packages. Training should cover:
- Health promotion, culturally sensitive counseling, and home-based care.
- Communication, recordkeeping, and basic data collection.
- Emergency referral procedures and ethical considerations (e.g., confidentiality and informed consent).
- Equip CHWs with job aids, referral tools, and reporting booklets. Offer continuous support through coaching, supervision, refresher training, and mentorship.
5. Develop a Sustainable CHW Compensation Mechanism
Design a fair compensation strategy that includes regular salaries or stipends, especially in low-income contexts. Payment improves performance, accountability, and retention. Inadequate compensation – especially when combined with weak supervision – may lead to poor service delivery or informal practices.
6. Equip and Deploy CHWs
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Deploy CHWs based on community needs and ensure they are equipped with essential tools and supplies. Key functions include:
- Medicine distribution: Provide iron/folic acid, ORS, chlorhexidine, contraceptives (where permitted), and misoprostol.
- Community mobilization: Lead outreach and education efforts, dispel myths, and support health campaigns (e.g., immunizations).
- Home-based care: Offer counseling, referral, and support for practices such as exclusive breastfeeding and kangaroo mother care.
- Ensure CHWs are linked to the nearest health facility for supervision and emergency referrals.
7. Document and Report Community Efforts
Use Ministry of Health-approved tools to record and report CHW activities. Include data on community referrals, home visits, services delivered, and health promotion events. Accurate documentation supports planning, accountability, and system-wide learning.
What’s the Evidence
Studies have shown that CHWs contribute to higher rates of antenatal visits and improved maternal health behaviors. Their involvement in community education and support encourages expectant mothers to seek timely and appropriate healthcare services.
Source: bmcpublichealth.biomedcentral.com
Key Indicators
1. Linking community to facilities
- Referrals and Linkages: Percentage of referred clients who reach the health facility and receive the needed services, disaggregated by condition. (ANC, delivery, PNC, immunization).
- Household Visits Conducted: Number of MNCH-focused home visits per month by CHWs, disaggregated by type of visit (ANC, PNC, newborn care, child health).
- Community Dialogues Held: Number of health education sessions and community dialogues on MNCH.
2. Community-based care across the continuum of care
- Attributable decline in early neonatal mortality rate resulting from early identification and referral of at-risk newborns.
- Marginal reduction in preventable maternal risk case incidence rate (postpartum hemorrhage).
- CHW Performance and Retention: Percentage of CHWs leaving the program within a specific period.
- Training Coverage: Percentage of CHWs trained on MNCH services.
- Data Reporting Rates: Percentage of CHWs submitting timely and complete reports.
3. Community-level advocacy and accountability
- Community Participation: Level of community involvement in program planning, implementation, and monitoring.
- Supervision Visits Conducted: Frequency and quality of supportive supervision provided to CHWs.
- Resources Mobilized: Amount of funding set aside to support community-based MNCH programs.
4. Community-based interventions to promote healthy practices and care-seeking behaviors
- Increase in demand for health services.
- Marginal increase in facility attendance for ANC, skilled birth attendants, and postnatal care coverage
- Prevalence of postpartum depression: Assessed through the number of cases screened by CHWs, if trained.
- Number of high-risk cases referred and transported to health facilities with treatment and care initiated.
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Tips
- Support and motivate the CHWs.
- Successful community-driven models for expanding delivery of quality MNCH services require both the community and facility levels to work together effectively and neither can benefit from the available resources and infrastructure.
- Involve the community in the design of community-based interventions. Allowing communities to take an active part in the decision-making and implementation processes leads to the successful implementation of community-health intervention packages.
- Tailor each program requiring the deployment of CHWs to communities’ specific needs, as well as cultural and religious beliefs and practices.
- Leverage technology to optimise CHW performance. Evidence suggests that mobile health (mHealth) tools can boost CHW effectiveness in areas with limited resources. Mobile technology assists CHWs in collecting thorough and accurate data, provides timely information and reminders about healthcare practices, and supports training, peer learning, and performance monitoring. Essentially, mHealth enhances CHW capabilities and improves healthcare delivery.
- Nonfinancial incentives can also play a key role in the overall satisfaction and motivation of CHWs. One such incentive is the certification of training so that CHWs may gain recognition and professional support from superiors. This may motivate CHWs to continually improve the quality of the care they provide.
Challenges
- Limited Allocation of Training and Renumeration Resources: CHWs often lack access to essential resources, such as supplies, transportation, and communication tools. This can limit their ability to effectively facilitate referrals and linkages.
- Integration with the Health System: CHW programs are not always well-integrated into the formal health system, leading to fragmented care and missed opportunities for collaboration.
- Task Burden and Complexity: Although promising evidence is emerging on the roles of CHWs in the delivery of community-based MNCH services, increasing the number of tasks required from CHWs has also initiated a debate on the potential for overburdening CHWs and compromising quality.
- Quality of Community-Based Care: One of the main concerns is making sure that the care that is given in communities satisfies quality standards, and two essential tools for doing so are supervision and training. The CHW subsystem often lacks adequate supervisory and training mechanisms. Training of CHWs should take into account differences in cultural and religious beliefs as well as education to ensure that CHWs – particularly those with lower levels of education or literacy – can better prepare for and handle real-life scenarios.
- Sustainability: Ensuring the long-term sustainability of CHW programs requires adequate funding, supportive policies, and community ownership.
Key Resources
- Integrated Management of Pregnancy and Childbirth: Pregnancy, Childbirth, Postpartum and Newborn Care (BEmONC). WHO, UNFPA, & UNICEF
- Quality Assurance Package for Midwives. Republic of the Philippines DOH
- Quality Assurance Package for Midwives: Facilitator’s Guide. USAID Philippines 2014
- Strengthening Public-Private Partnership in Expanding Hospital-based Provision of MNCHN Services. USAID Philippines 2014
- Managing Complications in Pregnancy and Childbirth. WHO & Dept. of Reproductive Health and Research 2007
- Foundation Module: The Midwife in the Community. WHO & ICM 2008
- Managing Prolonged and Obstructed Labor. WHO & ICM 2008
- Managing Puerperal Sepsis. WHO & ICM 2008
- Managing Postpartum Haemorrhage. WHO & ICM 2008
- Caring for the sick child in the community. WHO & UNICEF 2011
- Definition of skilled health personnel providing care during childbirth. WHO, UNFPA, UNICEF, ICM, ICN, FIGO, & IPA 2018
- Optimizing health worker roles for maternal and newborn health through task shifting. WHO 2012
- Midwifery education and care. WHO
