Community-based Information and Service Providers
Community health workers are an effective cadre to bring MNC information and services to communities. CHWs have an affinity and understanding of the community that they serve because they are known in their community and come from the same or a similar cultural background. Historically, CHWs have been trained to counsel women during pregnancy, refer women if complications are identified, and accompany women to a health facility to give birth. More recently, CHWs also have been making PNC home visits, and the global community is assessing whether CHWs can distribute and administer misoprostol to prevent PPH, provide injectable contraceptives (see Family Planning TRM), and diagnose community members for malaria and treat or refer (see Malaria TRM), as appropriate. When working with CHWs, it is important to understand if and where they fit in the national health system, what other responsibilities they may have, and how to make their activities sustainable.
Traditional birth attendants are a main source of pregnancy-related care in many settings, yet most have received no formal education or training and are illiterate. Although many governments are developing policies that promote childbirth in facilities with a skilled attendant and discourage childbirth in homes, women still give birth in settings with just family members or a TBA. It is important, therefore, that TBAs be considered stakeholders who can be trained to provide education and counseling and some elements of ANC and PNC in their communities. They can serve as a link to the formal health system to increase access to skilled attendance at birth.
Mobile outreach services also can link communities to the health system. In many areas, the public health system offers ANC monthly at outreach posts through health facility workers, which can be an excellent opportunity for women to access care without needing to travel to a health facility. These outreach posts, however, may be understaffed or lack supplies, which can severely limit quality of care or render them non-functional.
Families, particularly the husband or father, should be involved in birth preparations and should be ready to act if complications occur. Partners also should be tested and treated for STIs and be involved in family planning decisions. Depending on the culture, other family members such as mothers-in-law (grandmothers) may be important decision-makers and should be included when health messages and advice for the mother are shared.
Private sector actors can provide access to resources and techniques that increase MNC uptake through media outlets, development of job aids, communication materials, and transportation.
Community Agent Challenges
When designing a community-based program that uses community agents, it is important to consider the following points:
- Maintaining a cadre of motivated, well-trained CHWs who will remain in place after the program ends requires creativity and planning.
- Supervising, mentoring, and supporting CHWs can be complex and costly, yet these components are essential for maintaining the quality of the program.
- Establishing and maintaining links to health facilities is an ongoing task.
 Sibley, et al. (2009, p. 2) conclude, “The potential of TBA [trained birth attendant] training to reduce peri-neonatal mortality is promising when combined with improved health services. However, the number of studies meeting the inclusion criteria is insufficient to provide the evidence base needed to establish training effectiveness.” Sibley L, et al. Traditional birth attendant training for improving health behaviours and pregnancy outcomes (Review). The Cochrane Collaboration. Cochrane Library 2009, Issue 2.