Dashboard Philippines: Demand Generation Engaging Barangay Health Workers

Philippines Toolkit: AYSRH Demand Generation

Engaging Barangay Health Workers in Implementing AYSRH and Family Planning Programs

This intervention provides guidance on how to engage Barangay Health Workers (BHWs) in implementing adolescent and youth sexual and reproductive health (AYSRH) and family planning (FP) programs at the community/village level. BHWs are people who have undergone training under any accredited government or non-government organization, and voluntarily render primary health care services, referrals and follow-up in the community (BHW Facilitator Guide, 2022). This intervention provides information related to:

Training BHWs to counsel clients and provide contraceptive information and select short-term FP services (oral contraceptive pills, condoms) to hard-to-reach communities.
Linking BHWs to health facilities for commodities, including referrals
Promoting sexual and reproductive health to households by emphasizing the value of safe sex, desired family size and improved health-seeking behaviors.
Sharing knowledge by providing information, education and communication on FP counseling, birth spacing, contraception, and disease prevention and control.
Supervising BHWs to ensure AYSRH/FP promotion in communities and ensuring their motivation.
Monitoring the health status of household members – especially teenage mothers of the service area.
Maintaining and updating list/records of health activities.

Note: Local government units vary in the terminology used and engagement of BHWs. For this approach, BHWs collectively consist of Barangay Service Point Persons, Barangay Population Volunteers and Barangay Nutrition Scholars that help in the AYSRH and FP programs.

What are the benefits?

Building the capacity of BHWs to support implementation of demand generation and service delivery for AYSRH/FP is important because they serve as a critical bridge from the community to services by providing referrals to the nearest facility, information on services and the benefits of contraceptives. Some BHWs are allowed to deliver short-term methods including OCP and condoms directly to the women and men in their communities. In addition, fully trained and capacitated Barangay Health Workers serve to:

Provide knowledge and improve clients’ attitudes towards family planning
Provide greater access to and demand for contraceptive services
Act as credible and trusted sources of health information and AYSRH/FP services within the local government units
Provide quality health care services to youth or women of reproductive age on counseling, information on a variety of FP methods including short- and long-acting reversible contraceptives (SARCs and LARCs), method provision of SARCs (OCP, condoms), and referrals to services. (BHW must complete required trainings including the Dept of Health’s (DOH) BHW Formal Training Course and the DOH FPCBT1 Course to offer training and methods).
- Serve as the first touchpoints where teenage mothers and fathers are able to access community AYSRH services, especially in hard-to-reach areas.
- Provide referrals, follow-up care and home visits.

How to Implement

The following steps are key to effective engagement of BHWs in implementing AYSRH/FP activities:

Step 1: Train and orient BHWs on AYSRH/FP

BHWs may be trained through the DOH BHW Formal Course (DOH BHW Reference Manual) or through the Barangay Health Services NC II certification course (BHS NC II) as offered by the Technical Education and Skills Development Authority (TESDA). BHWs in the barangays can also undergo additional training as deemed necessary by the City Health Office. These can include training on the basics of the adolescent job aid (AJA), family planning competency-based training 1 (FPCBT1) and other trainings conducted by the Commission on Population and Development (POPCOM) and the Department of Health and/or City Health Office.

BHWs are to fulfill the roles of advocate of health programs; educator to guide the community on health priorities of the city and provide a variety of contraceptive methods; disseminator of health updates; “coordinator” of health services; “record-keeper” of health data, activities and events in the community; and health care service provider. (DOH BHW Facilitator’s Guide).

As the barangay-level health promotion officers & community organizers in their areas, BHWs should also undergo additional trainings/seminars that can enhance their sense of leadership and ownership (LAYFC), as well as improve their capacity to act as non-judgmental, non-biased service providers.

Step 2: Equip the BHWs

Provide BHWs with the community tracking tool (DOH Target Client List) to account for AYSRH/FP services availed by teenage mothers and fathers and women of reproductive age. Data from the Target Client List should be reported and analyzed at the city level. Family planning products and commodities offered in the city’s population/health office should also be made available to the Barangay Health Stations for distribution by their respective BHWs. Commodities will be provided by their respective local government unit through their city population office.

Step 3: Support and motivate the BHWs

Nurses or midwives assigned to oversee the BHWs conduct monthly meetings to review the AYSRH and FP activities and plan for the month. City nurse and midwives-in-charge provide supportive supervision, coaching and recognition of the best practices performed by BHWs.

For every capacity building activity, always assess their retention of knowledge through repeat examination/return demonstrations. Acknowledge their improved competency through the issuance of a certificate or the provision of promotional materials and supplies, like t-shirts, bags, caps, umbrella, and other IEC materials.

Step 4: Monitor the work of BHWs

The LGU, through the Municipal Health Officer/Municipal Population Office will conduct monthly and/or quarterly Barangay Health Board meetings to address implementation and performance issues. Use data for continuous improvement (Data for decision-making). The Municipal Health Officer/Municipal Population Officer should provide regular mentoring to reiterate/update knowledge and coaching to the BHWs in order to provide feedback and constructive criticisms (Coaching). In his/her absence, the coaching will be taken up by the nurse or midwife. It is also important to monitor that the skills of the BHWs are maintained to standard. Annual repeat return demonstrations coupled with coaching can be a potent method in retaining knowledge.

Indicators for success

The efforts of the BHWs are measured through the following:

Number of BHWs trained compared to those in place
Number BHWs received training on FP
Number of clients reached through community-based distribution of FP services/commodities
Number of BHW monthly meetings where FP provision, counselling performance discussed, compared to those planned.
Number of BHW receiving supporting supervision from Nurse/Midwife
Number of eligible couples who received services from BHW.
Number of youth (10-14, 15-19) who received information, counselling and/or services
Number and % of institutional deliveries
Number of youth and WRA escorted for deliveries by BHW
Number of new FP acceptors recruited by BHW
% of BHW who have stocks of both condoms and pills
Number of BHW monthly meetings where FP performance and related issues were discussed
% of BHW who prioritized household visits to eligible couples, pregnant women and youth.
Number of teenage mothers, fathers referred for contraceptive methods each month
Number of community members referred for contraceptive methods each month

Resources needed

RA 7883 – An Act granting benefits and incentives to accredited Barangay health workers and for other purposes
DOH Barangay Health Workers’ Facilitator’s Manual
DOH Family Planning Competency-based Training 1 Facilitator’s Guide
Adolescent Job Aid Training Facilitator’s Manual
USAID-DOH FHSIS Manual for FP-MCH Program
IEC materials (flipcharts, posters, slide decks)

What’s the evidence that BHWs strengthens AYSRH programming?

BHWs are competent and actively involved in providing information and dispelling myths and misconceptions in the community.
BHWs are instrumental in mobilizing communities for services during in-reaches and outreach activities. (Barangay Health Workers’ Reference Manual)
Community Health Workers are one of several proven high-impact practices in family planning. They have been shown to improve health outcomes by bridging geographic access barriers caused by health worker shortages; reducing financial barriers to clients by reducing the need for travel; decreasing social barriers and; increasing reach to women across social norms (CHWs HIP)
Owing to their membership within the community they serve and the nature of their work, BHWs are prime leaders and allies in delivering health service. Most BHWs display a predilection to leadership roles, as one of the most frequent criterions cited for their hiring was their consistent history of active involvement in their community and more intimate knowledge of their community’s issues owing to their personal connections with higher-ranking officials. Nevertheless, BHWs display a devotion to the job that extends beyond financial compensation, with some citing the opportunity to provide public service, the acclaim of being known throughout their community, the chance to form personal connections with a large number of people in their polity and a general sense of altruism as motivating factors for their continued service (Mallari E et al. 2020)

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Demand Generation Approaches

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Helpful Tips

Engage the BHWs in AYSRH and FP outreaches and in-reach activities
Expand the recruitment pool of BHWs to other less-represented groups (men, out-of-school youths, LGBT) to increase the potential reach of AYSRH and FP services.
LGU to ensure the availability of FP commodities and supplies to their respective Barangay Health Stations. Nurses and BHWs should be in-charge of providing feedback on inventory and stock-outs.
As BHWs are embedded within their respective communities, they can be a reputable, real-time source of information & feedback within their community. Consider taking their feedback when analyzing the impact of ongoing programs or in the creation of new strategies in their respective areas.
Provide IEC materials and other collaterals for BHWs so they can be easily recognized in the community as knowledgeable resources
Provide regular updates and feedback to the BHWs on emerging and re-emerging AY and FP issues
Equip BHWs with adequate information and IEC materials to be shared with teenage mothers and fathers, their parents and community gatekeepers
Strengthen the linkage of AYSRH services and FP commodities
Advocate for more resources and budget allocation for the training and benefits of BHWs
Equip BHWs with adequate information and IEC materials to be shared with teenage mothers and fathers, their parents and community gatekeepers
Strengthen the linkage of AYSRH services and FP commodities
Advocate for more resources and budget allocation for the training and benefits of BHWs

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Challenges

The engagement of a BHW requires regular capacity building activities to ensure that they have the right knowledge, attitude, and skills to serve adolescents and youth, as well as all women, in a non-judgmental and confidential manner.
Sometimes recruitment and selection of BHWs can be very political; a neutral and non-biased attitude of BHWs is required, especially to serve adolescents and youth and all women.
Honorariums and benefits for BHWs vary across cities and regions. Creating a formal & legal scheme of compensation that shares the burden of compensation between the city & barangay local governments is ideal- this is in acknowledgement of their significant roles as leaders in the barangays and extensions of the city’s health service arm. Health benefits, insurance coverage and other leave benefits should be explored by cities.
Establishing a formal training, education and regular career enrichment program for BHWs will provide them with a sense of career advancement while simultaneously ensuring a healthy pool of motivated volunteers