This poster was presented by Kristen Devlin at the International Conference on Family Planning (ICFP) in Kigali, Rwanda in November 2018. Since 2012, the Advancing Partners & Communities (APC) project has supported community health programs globally, with a focus on family planning. APC develops practical tools and approaches to help global and national level stakeholders identify knowledge and programming gaps to harmonize and scale community health programs. For decades, community health workers (CHWs) have been critical to reaching last-mile communities with family planning (FP) interventions. Information on the types of FP methods CHWs can provide, is often fragmented across country policies and strategies. To fill this gap, APC launched the Community Health Systems Catalog in 2014 as a one-stop 'shop' for key information on FP and community health policies and programs across 25 countries. This catalog identifies guidance on: 1) The number and type of CHW cadres that can provide FP interventions by country, 2) Which FP interventions CHWs can provide, 3) Gaps in FP policy guidance. This resource on community-based FP policies advances global knowledge and can be used to: Compary community-based FP interventions, inform dialog on FP task-sharing and -shifting, identify policy areas where clearer more comprehensive guidance is needed.

1. The CHS Catalog Includes
FP Data from 25 Countries
Afghanistan, Bangladesh, Benin, Democratic Republic of the Congo,
Ethiopia, Ghana, Haiti, India, Kenya, Liberia, Madagascar, Malawi,
Mali, Mozambique, Nepal, Nigeria, Pakistan, Philippines, Rwanda,
Senegal, Sierra Leone, South Sudan, Tanzania, Uganda, and
Zambia
KEY FINDINGS
How many CHW cadres could provide at least one FP intervention?
There was guidance for 60 CHW cadres, averaging 2–3 per country, with a range of skills, roles, scopes of work, and program
inputs that support them. Fifty-four of 60 CHW cadres (90%) could provide at least one FP intervention, and the remaining six
cadres did not provide any FP interventions. All 25 countries had FP guidance available for at least one CHW cadre. Policies for
individual CHW cadres varied in availability, quality, and content.
Which FP interventions could CHWs provide?
The graph below shows the number of countries that allowed at least one CHW cadre to provide or counsel on each FP method.
The majority of countries had clear guidance on most FP products. All countries allowed CHWs to provide OCPs and condoms,
and many countries approved CHWs to administer injectables. A number of countries permitted higher-level CHW cadres, such
as community midwives, to insert implants and/or IUDs. None could perform vasectomies or tubal ligations, though many CHWs
could refer clients to higher-level facilities for these services. Only some countries had explicit instruction for CHWs to provide
education or counseling on fertility awareness methods.
What were the gaps in FP guidance?
Over half of countries had absent or unclear information about whether CHWs could distribute ECPs, as shown in grey in the
map below. Many policies did not include fertility awareness methods in CHW training curricula or job descriptions but CHWs
were not explicitly forbidden to educate on them. Sierra Leone, however, had a newly updated CHW curriculum that did not
mention CycleBeads, so it was presumed this method was not within their scope.
KNOWLEDGE CONTRIBUTION
While community-based approaches to improving FP access
are far from new, guidance for CHWs had never been
aggregated and synthesized within and across countries
before APC’s Catalog. This resource on community-based
FP policies advances global knowledge and can be used to:
Compare community-based FP interventions permitted
across countries and CHW cadres within each country. As
national stakeholders design new policies and strategies
to scale up and strengthen FP programs, they often seek
examples and information from other countries to support
their planning and decision-making processes.
Inform dialogue on FP task-sharing and -shifting.
Exploring the policy data to identify which CHW cadres can
provide which FP services, and how different levels of CHWs
work together to reach last-mile communities, can provide
information on an array of service delivery models designed
to reach underserved women with critical FP services.
Identify policy areas where clearer, more
comprehensive guidance is needed. For example, this
analysis showed that policies should more clearly articulate
guidance for ECP provision and education on fertility
awareness methods by CHWs. This information will help
guide investments and decisions by donors, policymakers,
and program designers.
BACKGROUND & MAIN QUESTIONS
For decades, community health workers (CHWs) have been
critical to reaching last-mile communities with family planning
(FP) interventions. They have been instrumental in increasing
access to and voluntary uptake of contraceptives particularly
among poor, underserved women. In recent years, a growing
evidence base has shown that with adequate training,
supplies, and support, CHWs can safely and effectively
provide a range of contraceptive methods, resulting in an
expanded role for CHWs in FP provision.
Information on the types of FP methods CHWs can provide,
however, is often fragmented across country policies and
strategies. Community-level provision is sometimes absent
from FP guidelines, revealing a global knowledge and policy
gap in the community-based family planning policy landscape.
To fill this gap, APC launched the Community Health Systems
Catalog in 2014 as a one-stop ‘shop’ for key information on
FP and community health policies and programs across 25
countries deemed priority by USAID’s Office of Population
and Reproductive Health. APC developed the catalog to
identify guidance on:
1. The number and type of CHW cadres that can provide FP
interventions, by country.
2. Which FP interventions CHWs can provide.
3. Gaps in FP policy guidance.
APPROACH
APC updated the CHS Catalog in 2016–2017 using a
121-question survey that included questions about the
number and type of CHW cadres in each country and the FP
interventions they could provide, according to policy:
• Administration or provision of the following FP
products and procedures: condoms, oral contraceptive
pills (OCPs), injectable contraceptives, emergency
contraceptive pills (ECPs), implants, intrauterine devices
(IUDs), and permanent methods.
• Information, education, and/or counseling on the
aforementioned methods and non-product FP methods:
the Standard Days Method, CycleBeads, lactational
amenorrhea method, and ‘other fertility awareness
methods,’ such as the two-day and rhythm methods.
Country experts and APC staff reviewed community health
policies, strategies, curricula, and other documents to
complete the questionnaire through an electronic platform.
Country authorities vetted policies when possible. APC staff
performed data quality checks and analyzed data by
tabulating and aggregating FP interventions by CHW cadre
and country.
Since 2012, the Advancing Partners &
Communities (APC) project has supported
community health programs globally, with
a focus on family planning. APC develops
practical tools and approaches to help
global and national-level stakeholders
identify knowledge and programming
gaps to harmonize and scale community
health programs.
Kristen Devlin | Kimberly Farnham Egan | Tanvi Pandit-Rajani
JSI Research & Training Institute, Inc., 1616 Fort Myer Drive, 16th floor, Arlington, VA, USA
Which family planning methods can community health
workers provide? Policy data from 25 countries
Across these 9 countries, 17 cadres could provide
ECPs, and 2 countries did not allow any CHWs to
provide them.
The 14 other countries did not capture information
on ECPs in recent and available community
health policies.
13
12
13
11
1
4
21
10
25 25
25
20
5
21
4
22
3
2
9
14
15
Info on
Standard Days
Method
CycleBeadsInfo on
Lactational
Amenorrhea
Method
Other Fertility
Awareness
Methods
(TwoDay,
Rhythm, etc.)
Condoms Oral
Contraceptive
Pills
Injectables Implants IUDsEmergency
Contraceptive
Pills
Permanent
Methods
Yes, policies allow at least one CHW cadre to provide No, policies do not allow or include Information unavailable or unclear
Policy Guidance for CHW Provision of Emergency
Contraceptive Pills
Number of Countries with Policy Guidance for Family Planning Methods
ACKNOWLEDGEMENTS: Advancing Partners & Communities (APC) is a cooperative agreement
funded by the U.S. Agency for International Development under Agreement No.
AID-OAA-A-12-00047, beginning October 1, 2012. APC is implemented by JSI Research & Training
Institute, Inc., in collaboration with FHI 360.
We acknowledge the contributions of the participating health workers and Ministry of Health staff.
The views expressed do not necessarily reflect the views of USAID or the United States Government.