Population Council Research that makes a difference

In most developing countries, rural areas lag far behind urban areas in terms of contraceptive use and reproductive health status. Hospitals and health centers alone cannot serve the reproductive health needs of rural communities. To help improve this situation, in the 1950s community-based programs providing family planning services and information began appearing in rural areas to complement facility-based services.

Different levels of health providers deliver different services, depending on their education and training. Ideally, each provider level works in collaboration with other levels to decrease duplication of effort and allow for more efficient service delivery. A community volunteer with minimal training may be responsible for health education and referral within his or her community, while a professionally trained mid-level health worker with greater responsibilities provides services to more than one community. This service-delivery model is referred to as a "dual-cadre model." Programs with only a single type of worker delivering services to a village are referred to as a "single-cadre model." 

In October 2010, the Population Council began a five-year USAID-funded study to understand how public-sector, dual-cadre family planning and maternal, neonatal, and child health (FP/MNCH) programs perform in different settings and how each cadre functions in relation to the other. This project will generate and disseminate knowledge about community-based delivery of FP/MNCH services and will provide technical support to strengthen community-based programs in five USAID priority countries: Ethiopia, Ghana, India, Kenya, and Pakistan.

Phase I of the project, lasting 12 months (October 2010–September 2011), provided a comprehensive understanding of the variety, organization, and effectiveness of FP/RH community health worker programs globally through a systematic review.  Phase I also provided in-depth assessments of existing dual-cadre models in Ethiopia, Ghana, and India.

Phase II, lasting 36 months, will include technical assistance to strengthen the Ethiopia, Ghana, and India models if gaps and opportunities are identified, and will test the feasibility, effectiveness, and costs of restructuring two existing single-cadre public-sector community-based models into dual-cadre models in Kenya and Pakistan.