- Maintaining a cadre of motivated and well-trained CHWs that will remain in place after a program ends requires creativity and planning.
- Supervising, mentoring, and supporting CHWs and geographically scattered community depots and drug shops can be complex and costly, yet these components are essential for maintaining the quality of the program.
- Establishing and maintaining links to health facilities that provide other methods is an ongoing task.
- CHWs, community depots, and drug shops have limits in the range of methods they can distribute, and thus clients may still need to travel to a health facility for their method of choice.
CBFP is a less appropriate and less cost-effective choice when FP awareness and knowledge are high, contraceptive prevalence is relatively high, and a sufficient number of fixed health facilities are accessible and offer a range of methods. There are examples where the need for CBFP services has naturally decreased as the demand for FP and the quality and access to the health services and facilities increased. In this case, CBFP, and CHW provision of FP in particular, can be seen as an interim strategy to raise demand and access, recognizing that once this is accomplished, the expense for services at the community level may no longer be necessary.
CBFP programs (especially those working with CHWs) should take into account the following:
- Logistics and supplies: A CBFP program depends on having a reliable source of commodities and supplies. This is often through the local health center, although it may also be through the local social marketing distribution system. Products are typically procured with money obtained through cost recovery, and/or may be subsidized by the government or donor. CHWs must know the procedures for replenishing their FP commodities and other supplies, know who is responsible for resupplying, and have a system to maintain good communication with their supplier.
- Training and supervision: A CBFP program should develop criteria to identify and select women and men to serve as effective CHWs. This should be done in consultation with community members. Upon selection, training for CHWs takes place, usually lasting at least two weeks. Programs should also include a plan for regular refresher training of CHWs and on-the-job training as part of regular supervision. For supervision and support, CHWs should be linked to the local health center and a government health worker. A supervisor’s task is to help CHWs do their work correctly and effectively by: (1) reviewing reports and record keeping; (2) observing the CHW’s counseling skills for client and group education sessions; (3) giving immediate, tactful feedback to correct errors in information or approach, to praise what the agent did well, and to suggest areas where the agent can improve; and (4) mentoring the CHW, by carrying out activities with her or him and demonstrating the desired practice.
- Referral system: A CBFP program will need to create or strengthen the referral systems for the health facility to increase client access to LAPMs. Facility workers can also refer clients back to CHWs, who can monitor FP clients for side effects and answer clients’ questions about methods they obtained at the facility.
- Volunteer management and motivation: CBFP programs exist with both paid and volunteer CHWs. Volunteer CHWs typically receive modest incentives, such as supplies and increased status in the community. Retaining volunteer CHWs can sometimes be addressed by expanding the “portfolio” of the CBFP program to include other socially marketed products such as insecticide-treated bednets, and/or expanded health roles, which increase their credibility, status, and access to training allowances.
- Scale and sustainability plan: CHW programs may be implemented on a relatively small scale due to the level of training and support required. Ownership at the ministry of health is essential for finding long-term support for supervision and refresher training to sustain CHW programs.
Please also see the below sections on CBFP in this toolkit:
Please also see the below sections on CBFP in this toolkit:Please also see the below sections on CBFP in this toolkit: