CARE regularly partners with governments, communities, and FHWs to improve the accessibility and quality of health services for women and girls. From Malawi to India to Afghanistan and beyond, we have seen how a little support to health workers can go a long way toward addressing health challenges and enhancing quality of life for individuals, families, and communities.
What has been accomplished?
FHWs have strengthened their existing clinical skills and learned new ones
Since 2011, over 800 providers received training on family planning counseling and service provision through our SAFPAC program in DR Congo, and nearly all of them developed competency in these areas (89-96%, depending on the service). The Bihar Technical Support Program in India has used an incremental learning approach with FHWs to instruct them to provide proper family planning counseling, antenatal and postnatal care, child immunizations, infant feeding, and other critical family health services. FHWs participating in the sessions have reported that their knowledge and technical skills have been enhanced, and they feel more empowered, motivated, and proud than they did before the trainings began.
FHWs have access to tools and information that make their jobs easier
Another innovation coming out of the Bihar Technical Support Program is CAS (Common Application Software), a suite of mobile applications designed to help FHWs coordinate and monitor the services they are providing to women and children in their communities. Through a range of modules available on their phones, FHWs receive step-by-step guidance on the proper advice and services they should be giving to a particular client at a particular time.
Health systems are reaching traditionally marginalized/neglected groups
Research shows that adolescent girls are often unable to access quality, rights-based sexual and reproductive health (SRH) information and services, so CARE works with FHWs to build their capacity to provide youth-friendly SRH services (as seen in DR Congo with the Vijana Juu project and in Niger and Bangladesh with IMAGINE).
People are more likely to seek services for themselves and their family members when needed
The GSK Community Health Worker Initiative in Bangladesh contributed to increasing the proportion of births attended by skilled health personnel by 24% (from 13.4% to 37.4%), benefitting 103,874 women. In Afghanistan, CARE’s Opportunities for Mothers and Infant Development project (also funded by GSK) saw some significant advances in health facility visits for ante-natal care (from 43.55% to 86% in one district and 39% to 89% in another). Improvements in health facilities enabled through the Bihar Technical Support Program contributed to an increase in attendance in outpatient departments and delivery loads in these facilities, and an improvement in overall patient satisfaction.
How did we get there?
By creating space for dialogue and conversation between FHWs and others in the community
In Malawi, we’ve seen significant impact in service utilization, provision, and satisfaction after using CARE’s Community Score Card (CSC) social accountability approach. One study found that pregnant women in communities that participated in the intervention received 20% more visits from health workers during their pregnancies than non-participants, and accessibility of reproductive and maternal health information increased by 22%.
By inviting community members and facility support staff to get involved
As it turns out, FHWs are more effective in their jobs when they are supported by others in the community. Through various projects, CARE has helped to mobilize and equip regular people without extensive health training and credentials to serve on community support groups (Bangladesh), as community-based disease surveillance monitors (DR Congo, South Sudan, Sierra Leone), youth sexual and reproductive health champions (DR Congo), and in other health volunteer roles. The Bihar Technical Support Program team found that non-clinical health staff had good ideas on how to improve the appearance of public health facilities where they worked, and when their recommendations were implemented, they felt more valued and took more pride in their work.
By focusing on rights and tackling unconscious bias
FHWs, like the rest of us, are only human, and they have their own values and beliefs that are likely to affect the way they provide services. Many of CARE’s SRH projects (including SAFPAC, IMAGINE, and TESFA) rely on approaches like Social Analysis and Action and VCAT to surface and challenge norms, beliefs, and biases among health workers that may impede their ability to provide rights-based health services to everyone who needs them.