Blogs by David Olson

Dakar Conference Shows that Community Health Workers also Vital in Family Planning

Posted by David Olson at 19:27, 30 November 2011

AMREF considers the shortage of community health workers (CHWs), particularly in rural areas, as one of the major challenges confronting health care in Africa, and it is one of our highest advocacy priorities. While sub-Saharan Africa has 24% of the global disease burden, it has only 3% of the world’s health workers (World Health Organization World Health Report 2006).

AMREF’s recent Position Statement on Community Health Workers stated that CHWs’ role is “imperative in achieving the health-related Millennium Development Goals, especially those related to HIV and AIDS, malaria, tuberculosis, maternal mortality and childhood diseases.”

Their role in family planning (FP) and reproductive health is equally critical, as is being made apparent this week in Dakar, Senegal, where the second International Conference on Family Planning — the largest gathering of family planning practitioners, advocates and supporters in the world — has placed CHWs high on the agenda. CHWs feature front and center in at least four major abstract-driven presentations as well as a luncheon roundtable and reception honoring the health worker, both organized by IntraHealth, one of our main partners in the new Frontline Health Workers Coalition.

Many of the case studies and findings from the front lines of global health being presented at the conference support AMREF’s position statement on CHWs. In that statement, AMREF stated its belief that: 

• CHWs are the most affordable and available category of human resources for health in Africa.

• Much of what a nurse or midwife does can be done as effectively, or sometimes even more effectively, by CHWs operating in the community and providing home-based care.

• Strong linkages and referrals between the community and the formal health system are imperative.

• Community participation needs to be continuously developed and supported.

• CHWs need to be integrated into the revised Human Resources for health strategic framework, including new strategies that enable CHWs to contribute more effectively.

• CHWs should be adequately compensated for their efforts.

• CHWs’ use of modern technology, especially the mobile phone, is critical to improving access to health care.

All of the CHW-related presentations at the Dakar conference show either the indispensable role played by the CHWs or innovative programs that are being implemented to address the issues raised above:

• KENYA: In a presentation entitled “Peer mentoring methodology for capacity building integrated HIV and FP/PNC services,” the Population Council tested the feasibility and acceptability of using an onsite peer mentorship program to improve the knowledge and skills of first line health workers to provide quality integrated HIV and postnatal/FP services. Eighty-seven percent of the “mentees” achieved the required level of competence in knowledge and skills over one year. During this time, an increase in use of long-term FP methods from 3.1% to 7.4% was noted.

• UGANDA: In a presentation entitled “The role of community-based organizations in expanding access to injectable contraception,” Save the Children US and FHI 360 demonstrated that the provision of injectables by CHWs was feasible, safe and acceptable. Save the Children is now exploring opportunities to expand community-based provision of injectables to other countries, including Francophone West Africa.

• NIGERIA: In a presentation entitled “Supportive supervisory visits (SSVs): A key tool in ensuring quality in family planning interventions,” the Society for Family Health showed that SSVs by doctors, nurses or midwives to community and service providers have proven “to be an invaluable means of on the job coaching for providers and through on-going series of SSV, providers have been found to exhibit more confidence and proficiency in providing quality family planning services.”

• INDIA: In a presentation entitled “Is there any effect of health workers' visits on women's contraceptive use in Uttar Pradesh?” a Futures Group study found that health workers' visits to married women in their homes helped increase contraceptive use from 35% in 2005 to 44% in 2010, which is highly significant. “One of the key findings is that health workers' visits significantly boosted the update of contraceptive use, which implies that grass roots level workers are keys to the FP program,” according to the abstract.

• EL SALVADOR, GUATEMALA AND NICARAGUA: In a presentation entitled “Women's experience using a certified network of IUD providers,”  PSI hired and trained a group of community-based health providers (CHPs) to promote FP services, specifically to insert and remove intrauterine devices (IUDs). Overall, women reported a positive experience with the CHPs. Most women reported the intention to continue using the IUD and would even recommend it to other women.

These presentations and others in Dakar this week show clearly that if community health workers in Africa and parts of the developing world are properly trained and supported, they can play a larger and more effective role in helping provide family planning to the 215 million women with no current access.

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