Integrating CHW in health systems vital in family planning

‘THE phrase “family planning” will disappear from the ministerial structure, as China grapples with a shrinking labour pool and rapidly ageing population’.

This statement caught most people by surprise when it was announced recently and for a good reason too.

For many, they will know the tough stance that China put in place to control the growing population in their country, where the country’s family planning commission, for nearly four decades, enforced the country’s notorious one-child policy.

“It is a historic change and watershed moment,” says Yi Fuxian, a long-standing critic of China’s birth control policy and a researcher, saying that China is shifting from population control to population development.

In Tanzania, however, the case is still different, with the country still grappling with various methods of family planning, where Tanzania plans to double the number of family planning users to 4.2 million by 2020 to reach a contraceptive prevalence rate of 60 per cent for all methods.

The concept of family planning in Tanzania is not new. What is new is the contraceptive methods which are given as part and parcel of the Maternal and Child Health services in a medical setting.

Child spacing, as we call it in Tanzania, has been practiced from time immemorial throughout the length and breadth of Tanzania.

The World Health Organisation (WHO) has defined family planning (FP) as a method that allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births.

Family planning is achieved through use of contraceptive methods and the treatment of involuntary infertility, and is a key component of comprehensive sexual and reproductive healthcare.

Despite the health and social benefits to mothers, their children and communities of good access to quality family planning services, global data shows that an estimated 215 million women of reproductive age who are married or in a union have an unmet need for family planning.

According to AMREF Health Africa, access to family planning is estimated to prevent about one-third of pregnancy-related deaths, as well as 44 per cent of neonatal deaths.

This is because timing and spacing of pregnancies, at least two years between births, helps to prevent adverse pregnancy outcomes, including high rates of prematurity, malnutrition and stunting in children.

One of the challenges of access to family planning in developing countries, according to AMREF, is the quality of health systems and supply chain management for reproductive health commodities, therefore the organisation believes that to improve access, family planning services should be integrated into general health services.

During a recent workshop organised by Amref Health Africa and councillors from Kishapu and Shinyanga district, the politicians said that medical barriers can limit the use of family planning services, even in situations where family planning services are physically accessible and economic barriers are few.

Luhende Masele, the Councillor of Didia ward in Shinyanga district says that in their area, family planning service providers are met with a myriad of challenges while catering for the residents of the area, part of the 15,000 population from the ward.

“Apart from facing a serious shortage of health facilities in the ward, we still face a serious challenge of lack of medical equipment and medicines, and we have been taking our pleas to the central government for assistance,” he says.

To improve access to high-quality family planning services in Shinyanga, the councillors said that there is need to engage Community Health Workers (CHW) who gets support from the district health system.

“A rising population without a commensurate increase in the capacity of the health system to handle demands can be catastrophic,” says Councillor Masele.

According to the WHO, although Africa is responsible for a quarter of the global burden of disease, it has less than 3 per cent of the global population of health workers.

CHWs, according to Amref, can help to reduce the cultural barriers to uptake of family planning services in rural Tanzania, because they understand the social dynamics of their communities and can effectively carry out counselling and distribution of condoms and birth control pills with limited resistance from members of the community.

“Investment in family planning requires adequate funding of community-based family planning programmes, with expanded roles for CHWs,” says Zando Mkwazu of Amref Health Africa, adding that this is a smart investment in the best interests of all as the country’s population rises.

He says that when appropriately designed and implemented, community health worker programmes can increase the use of contraception, particularly where unmet need is high, access is low, and geographic or social barriers to use of services exist.

In Tanzania, while the support on training CHWs started since independence, yet there has been insignificant improvement on CHW capacity to provide health services over decades.

The councillors from Shinyanga unanimously agreed that investment in family planning requires adequate funding of community-based family planning programmes, with expanded roles for CHWs.

During the workshop, participants discussed the process of selection and training of CHWs, the challenges in the day-to day activities in the communities and the best practices of community based health interventions in Shinyanga region, especially in Kishapu and Shinyanga districts.

In this respect, CHW can play a key role in the delivery of community health because they work closely with the village and the district authorities to whom they report, monitor pregnant women and children under five years, and are able to identify potential risks for the health of mothers and newborns/children.

CHWs, the councillors said, are most effective when supported by a clinically skilled health workforce, particularly for family planning services and maternal care, and deployed within the context of an appropriately financed primary healthcare system.

“However, CHWs have also notably proven crucial in settings where the overall primary healthcare system is weak, particularly in improving child and neonatal health,” says Dr Amos Mwenda, the Shinyanga Municipal Council Medical Officer.

He says that they also represent a strategic solution to address the growing realisation that shortages of highly skilled health workers will not meet the growing demand of the rural population in Shinyanga.

As a result, the need to systematically and professionally train lay community members to be a part of the health workforce has emerged not, simply as a stop-gap measure, but as a core component of primary healthcare systems in low-resource settings.

The importance of CHWs is not a new realisation, and there are long-standing efforts within communities across sub-Saharan Africa to merge successful community-based efforts with formal health systems strengthening initiatives.

This is reflected in national health system planning documents, large-scale deployments of CHW cadres and international interest in support of CHW expansion.


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