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Geneva, Switzerland, World Health Organization [WHO], 2018. 116 p.The guideline uses state-of-the-art evidence to identify effective policy options to strengthen community health worker (CHW) programme performance through their proper integration in health systems and communities. The development of this guideline followed the standardized WHO approach. This entailed a critical analysis of the available evidence, including 16 systematic reviews of the evidence, a stakeholder perception survey to assess feasibility and acceptability of the policy options under consideration, and the deliberations of a Guideline Development Group which comprised representation from policy makers and planners from Member States, experts, labour unions, professional associations and CHWs. Critical to the success of these efforts will be ensuring appropriate labour conditions and opportunities for professional development, as well as creating a health ecosystem in which workers at different levels collaborate to meet health needs. Adapted to context, the guideline is a tool that supports optimizing health policies and systems to achieve significant gains to meet the ambition of universal access to primary health care services.
Should trained lay providers perform HIV testing? A systematic review to inform World Health Organization guidelines.
AIDS Care. 2017 Dec; 29(12):1473-1479.New strategies for HIV testing services (HTS) are needed to achieve UN 90-90-90 targets, including diagnosis of 90% of people living with HIV. Task-sharing HTS to trained lay providers may alleviate health worker shortages and better reach target groups. We conducted a systematic review of studies evaluating HTS by lay providers using rapid diagnostic tests (RDTs). Peer-reviewed articles were included if they compared HTS using RDTs performed by trained lay providers to HTS by health professionals, or to no intervention. We also reviewed data on end-users' values and preferences around lay providers preforming HTS. Searching was conducted through 10 online databases, reviewing reference lists, and contacting experts. Screening and data abstraction were conducted in duplicate using systematic methods. Of 6113 unique citations identified, 5 studies were included in the effectiveness review and 6 in the values and preferences review. One US-based randomized trial found patients' uptake of HTS doubled with lay providers (57% vs. 27%, percent difference: 30, 95% confidence interval: 27-32, p < 0.001). In Malawi, a pre/post study showed increases in HTS sites and tests after delegation to lay providers. Studies from Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity (>/=98%). Values and preferences studies generally found support for lay providers conducting HTS, particularly in non-hypothetical scenarios. Based on evidence supporting using trained lay providers, a WHO expert panel recommended lay providers be allowed to conduct HTS using HIV RDTs. Uptake of this recommendation could expand HIV testing to more people globally.
Cervical cancer screening and management of cervical pre-cancers. Training of community health workers.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 92 p.The training manual is designed to assist in building capacity of community health workers (CHWs) in educating women and community members on relevant aspects of cervical cancer prevention. The manual aims to facilitate improvement in communication skills of CHWs for promoting uptake of cervical cancer screening services in the community. The primary intention of this manual is to assist CHWs in spreading community awareness on cervical cancer prevention and establishing linkage between the community and available screening services. The information and instructions included in the manual can be used by both the facilitators and CHWs while participating in the training. The manual contains nine different sessions to assist CHWs to be acquainted with different aspects of cervical cancer prevention at the community level with focus on improving their communication skills. Each session contains key information in ‘question and answer’ format written in simple language so that CHWs can comprehend the contents better. At the end of each session, there are group activities like role plays, group discussion and games for active learning. These are intended to give opportunity to CHWs to learn by interacting with each other and also relate themselves with their roles and responsibilities at the community level. The manual includes ‘notes to the facilitator’ on how to conduct various sessions as per the given session plan. A set of ‘Frequently Asked Questions’ has been included to help the CHWs provide appropriate information to women and community members.
Strengthening the capacity of community health workers to deliver care for sexual, reproductive, maternal, newborn, child and adolescent health.
Geneva, Switzerland, World Health Organization [WHO], 2015. 20 p.Government institutions, United Nations agencies, and global partners have been repositioning the role that community health workers (CHWs) can play in increasing access to essential quality health services in the context of national primary health care and universal health coverage. Given the growing momentum and interest in training CHWs, the United Nations health agencies (H4+) have developed this technical brief to orient country programme managers and global partners as to key elements for strengthening the capacity of CHWs, including health system and programmatic considerations, core competencies, and evidence-informed interventions for CHWs along the SR/MNCAH continuum of care. These key elements need to be adapted and contextualized by countries to reflect the structure, gaps, and opportunities of the national primary health care system, the interaction between the health sector with other sectors, and the specific roles and competencies that CHWs already have within that system. These key elements should also guide H4+ members and partners to take a joint and harmonized approach to supporting countries in their capacity-development efforts. Annex 1 lists SR/MNCAH interventions that CHWs can perform based on the best available evidence and existing WHO guidance.
Caring for newborns and children in the community. Planning handbook for programme managers and planners.
Geneva, Switzerland, World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health, 2015. 168 p.Prevention and treatment services need to be brought closer to children who are not adequately reached by the health system. To help meet this need, WHO and UNICEF have developed state-of-the-art packages to enable community health workers to care for pregnant women, newborns and children. Caring for Newborns and Children in the Community comprises three packages of materials for training and support of CHWs. Countries will assess their current community-based services and choose to what extent they are able to implement these packages for improving child and maternal health and survival: (1) Caring for the newborn at home, (2) caring for the child's healthy growth and development, (3) caring for the sick child in the community.
Brazzaville, Republic of the Congo, WHO, Regional Office for Africa, 2017. 23 p. (Policy Brief)Community health worker (CHW) programmes have seen a renaissance in the last two decades and now many countries in Africa boast of such national or substantial sub-national programmes. The 2013 Third Global Forum on Human Resources for Health concluded that CHWs and other frontline primary health care workers “play a unique role and can be essential to accelerating MDGs and achieving UHC”, and called for their integration into national health systems. The Ebola virus disease (EVD) outbreak of 2014-2015 highlighted the imperative of ensuring the functioning of the health systems at the community level for both their day-to-day resilience and disaster preparedness. The purpose of this policy brief is to inform discussions and decisions in the World Health Organization (WHO) African Region on policies, strategies and programmes to increase access to primary health care (PHC) services and make progress towards universal health coverage (UHC) by expanding the implementation of scaled-up CHW programmes. This brief summarizes the existing evidence on CHW programmes with a focus on sub-Saharan Africa and offers a number of context-linked policy options for countries seeking to scale up and improve the effectiveness of their CHW programmes, particularly with regard to needs such as those of Guinea, Liberia and Sierra Leone, the three countries that were the most affected by the 2014-2015 EVD outbreak. For the purposes of this policy brief, a broad definition of CHW is used. CHWs are individuals “carrying out the functions related to health care delivery [who are] trained in some way in the context of the intervention [but have] no formal professional or paraprofessional certificated or degreed tertiary education [in a health-related field]”). WHO states that CHWs “should be members of the communities where they work, selected by the communities, answerable to the communities for their activities, and supported by the health system but not necessarily a part of its organization”. For the purposes of this brief, a working definition for a scaled-up CHW programme has been developed, where the term refers to a programme that is designed to be more than a pilot or demonstration project and has the intention of covering a substantial population size or geographic area, depending on the country’s context. (Excerpts)
New York, New York, UNICEF, Program Division, Health Section, Knowledge Management and Implementation Research Unit, 2014 Jul.  p. (Maternal, Newborn and Child Health Working Paper)In addition to a comprehensive literature review, the study used a cross-sectional survey with close- and open-ended questions administered to UNICEF Country Offices and public sector key informants to investigate and map CHW characteristics and activities throughout the region. Responses were received from 20 of the 21 UNICEF Country Offices in the UNICEF East and Southern Africa region in May-June 20013. Data on 37 cadres from across the 20 countries made up of nearly 266,000 CHWs form the basis of this report. This report catalogues the types and characteristics of CHWs, their relationship to the broader health system, the health services they provide and geographic coverage of their work.
Feasibility and validity of using WHO adolescent job aid algorithms by health workers for reproductive morbidities among adolescent girls in rural North India.
BMC Health Services Research. 2015 Sep 21; 15(1):400.Background: High prevalence of reproductive morbidities is seen among adolescents in India. Health workers play an important role in providing health services in the community, including the adolescent reproductive health services. A study was done to assess the feasibility of training female health workers (FHWs) in the classification and management of selected adolescent girls' reproductive health problems according to modified WHO algorithms. Methods: The study was conducted between Jan-Sept 2011 in Northern India. Thirteen FHWs were trained regarding adolescent girls' reproductive health as per WHO Adolescent Job-Aid booklet. A pre and post-test assessment of the knowledge of the FHWs was carried out. All FHWs were given five modified WHO algorithms to classify and manage common reproductive morbidities among adolescent girls. All the FHWs applied the algorithms on at least ten adolescent girls at their respective sub-centres. Simultaneously, a medical doctor independently applied the same algorithms in all girls. Classification of the condition was followed by relevant management and advice provided in the algorithm. Focus group discussion with the FHWs was carried out to receive their feedback. Results: After training the median score of the FHWs increased from 19.2 to 25.2 (p - 0.0071). Out of 144 girls examined by the FHWs 108 were classified as true positives and 30 as true negatives and agreement as measured by kappa was 0.7 (0.5-0.9). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 94.3 % (88.2-97.4), 78.9 % (63.6-88.9), 92.5 % (86.0-96.2), and 83.3 % (68.1-92.1) respectively. Discussion: A consistent and significant difference between pre and post training knowledge scores of the FHWs were observed and hence it was possible to use the modified Job Aid algorithms with ease. Limitation of this study was the munber of FHWs trained was small. Issues such as time management during routine work, timing of training, overhead cost of training etc were not taken into account. Conclusions: Training was successful in increasing the knowledge of the FHWs about adolescent girls' reproductive health issues. The FHWs were able to satisfactorily classify the common adolescent girls' problems using the modified WHO algorithms.
Maximizing the impact of community-based practitioners in the quest for universal health coverage [editorial]
Bulletin of the World Health Organization. 2015; 93:590-590A.Maximizing the impact of community-based practitioners entails that (i) national policy-makers move towards the full integration of community-based practitioners in public health strategies, allowing these cadres to benefit from formal employment, education, health system support, regulation, supervision, remuneration and career advancement opportunities; (ii) development partners and funding agencies see the value of investing in these cadres and contribute to the capital and recurrent costs incurred when expanding this workforce; (iii) normative agencies such as WHO and ILO address the evidence and classification gaps by developing more precise definitions and categories for these cadres. To make the most of the investment opportunities that community-based, mid-level and advanced practitioners represent, policy-makers need to jointly support this agenda. (Excerpts)
Community health care: Bringing health care at your door. Report of side event at 67th World Health Assembly.
[Geneva, Switzerland], World Health Organization [WHO], Global Health Workforce Alliance, 2014.  p.The side event held at the 67th World Health Assembly provided an opportunity to deliberate on integrated community health care (CHC) in attaining the Millennium Development Goals (MDGs) and Universal Health Coverage (UHC). The session also explored effective policies and strategies that could be used to remove the obstacles to deliver quality health care and positioning community health workers (CHWs) as an integral part of local health teams.
[Johannesburg, South Africa], University of the Witwatersrand, Centre for Health Policy, Health Systems Knowledge Network, 2007 Jul.  p.In this paper I discuss gender issues manifested within health occupations and across them. In particular, I examine gender dynamics in medicine, nursing, community health workers and home carers. I also explore from a gender perspective issues concerning delegation, migration and violence, which cut across these categories of health workers. These occupational categories and themes reflect priorities identified by the terms of reference for this review paper and also the themes that emerged from the accessed literature. This paper is based on a desk review of literature accessed through the internet, search engines, correspondence with other experts and reviewing bibliographies of existing material. These efforts resulted in a list of 534 articles, chapters, books and reports. Although most of the literature reviewed was in English, some of it was also in Spanish and Portuguese. Material related to training and interpersonal patient-provider relations that highlights how occupational inequalities affect the availability and quality of health care is covered by other review papers commissioned by the Women and Gender Equity Knowledge Network. (Excerpt)
Geneva, Switzerland, WHO, 2009. 7 p. (WHO/FCH/CAH/09.02)This new statement provides critical new guidance to governments, USAID missions, UN agencies, non-governmental organizations (NGOs) and other development partners on prevention and management approaches that can be delivered through home visits in the baby’s first week of life. Of the estimated 8.8 million children under 5 that die each year – 3.7 million are newborn infants who die within the first four weeks after birth. Up to two-thirds of these deaths can be prevented through existing effective interventions delivered during pregnancy, childbirth and in the first hours, days and week after birth. A growing body of knowledge has shown that home visits by appropriately trained workers to provide newborn care can significantly reduce neonatal mortality even where health systems are weak. WHO and UNICEF therefore recommend home visits for the care of the newborn child in the first week of life (within 24 hours, on the third day and, if possible, on the seventh day of life) as a complementary strategy to facility-based postnatal care in order to improve newborn survival.
[Washington, D.C.], USAID, .  p.A technical consultation, co-sponsored by the World Health Organization (WHO), USAID, and Family Health International (FHI), was held June 15-17, 2009, at the WHO in Geneva to review the evidence and programmatic experience for community-based provision of injectable contraceptives. Thirty technical and program experts from countries and organizations reviewed the scientific evidence and experiences from programs that provided injectable contraceptives through community-based health workers (CHWs). This evidence and programmatic experience came from Africa, Asia, and Latin America and focused on depotmedroxyprogesterone acetate (DMPA). The evidence consistently showed that given appropriate training, CHWs can screen clients effectively, provide DMPA injections safely, and counsel on side effects appropriately, demonstrating competence equivalent to higher level facility-based providers of DMPA. Continuation of use of DMPA by clients of CHWs was as long as those of clients receiving injections at clinics. In addition, the vast majority of clients expressed satisfaction with CHW provision of DMPA. The Consultation concluded that sufficient evidence existed for national policies to support the introduction, continuation, and scale-up of community-based provision of progestin-only injectable contraceptives, especially DMPA. Provision of DMPA by CHWs will expand choice for underserved populations and contribute to reducing the unmet need for family planning. Operational guidelines for family planning should therefore reflect that appropriately trained CHWs can safely initiate use of DMPA and provide reinjection. (Excerpt)
Community-based health workers can safely and effectively administer injectable contraceptives: Conclusions from a technical consultation.
Research Triangle Park, North Carolina, FHI, 2009. 4 p.In June 2009, a technical consultation held at the World Health Organization (WHO) in Geneva concluded that evidence supports the introduction, continuation, and scale-up of community-based provision of progestin-only injectable contraceptives. The group of 30 technical and programme experts reviewed scientific and programmatic experience, which largely focused on the progestin-only injectable, depot-medroxyprogesterone acetate (DMPA). The experts found that community-based provision of progestin-only injectable contraceptives by appropriately trained community health workers (CHWs) is safe, effective, and acceptable. Such services should be part of a family planning programme offering a range of contraceptive methods. (Excerpt)
Bulletin of the World Health Organization. 2007 Oct; 85(10):740-741.Indonesia's maternal mortality rate is one of the highest in south-east Asia. One East Java district has introduced a novel scheme to reduce those deaths. In many rural areas of Indonesia, traditional ways of delivering babies remain popular. For example, in Ugaikagopa in the country's east, traditional healers take the pregnant woman to the middle of the forest to deliver the baby. They may use fibres taken from bamboo to cut the umbilical cord and wipe the newborns' bodies with guava leaves. The instruments used are not sterile and can lead to infection. The traditional healer, or dukun in Indonesian language or Bahasa, may not be able to deal with complications during labour, and by the time the mother gets to a local clinic it may be too late. As a result, maternal mortality in Indonesia is high compared to most south-east Asian countries. In 2005, there were an estimated 262 maternal deaths per 100 000 live births, compared with 39 per 100 000 in Malaysia and 6 per 100 000 in Singapore. Figures for Papua province from 2003 show even higher death rates: 396 per 100 000 live births. (excerpt)
Bethesda, Maryland, University Research Company, Quality Assurance Project, 2004 Dec. 47 p. (QAP / WHO Field Report)The traditional approach to malaria diagnosis has been examination by microscope of a thick blood smear from the individual suspected of being infected. In an attempt to provide a more rapid alternative, companies worldwide have developed malaria rapid diagnostic tests (RDTs). Although RDTs can be effectively used in clinical settings by trained personnel, their greatest potential use is in rural areas with limited access to health and laboratory facilities. Using RDTs for diagnosis at the community level will shorten the delay between the onset of symptoms and the beginning of appropriate treatment. It will also slow development of resistance and lead to significant cost savings by avoiding unnecessary use of antimalarials. However, achieving a high level of sensitivity and specificity with RDTs in this context will require a product designed, labelled, and explained so that community health workers (CHWs) can use it accurately with minimal formal training and supervision. In partnership with theWHO Regional Office for the Western Pacific, the Quality Assurance Project (QAP) carried out quality-design research in the Philippines and the Lao People's Democratic Republic to develop and test a generic RDT job aid, mainly pictorial, that could be adapted with little modification for use with different RDT products and in different cultural settings by health workers with low literacy skills and with little or no prior training in product use. (author's)
Bulletin of the History of Medicine. 2007 Summer; 81(2):407-430.Between 1947 and 1951 the Scandinavian-led International Tuberculosis Campaign tested more than 37 million children and adolescents for tuberculosis, and vaccinated more than 16 million with BCG vaccine. The campaign was an early example of an international health program, and it was generally seen as the largest medical campaign to date. It was born, however, as a Danish effort to create goodwill in war-ravaged Europe, and was extended outside Europe only because UNICEF in 1948 unexpectedly donated US $2 million specifically for BCG vaccination in areas outside Europe. As the campaign transformed from postwar relief to an international health program it was forced to make adaptations to different demographic, social, and cultural contexts. This created a tension between a scientific ideal of uniformity, on the one hand, and pragmatic flexibility on the other. Looking at the campaign in India, which was the most important non-European country in the campaign, this article analyzes three issues in more detail: the development of a simplified vaccination technique; the employment of lay-vaccinators; and whether the campaign in India was conceived as a short-term demonstration or a more extensive mass-vaccination effort. (author's)
Research Triangle Park, North Carolina, FHI, 2002.  p. (FHI Research Brief No. 6; RB-02-06E)Community-based workers worldwide use checklists to determine whether women are medically eligible to use combined oral contraceptives (COCs) or depot-medroxyprogesterone acetate (DMPA). However, problems may arise when outdated and inaccurate checklists are used. With input from dozens of experts, Family Health International developed new checklists that are easily understandable and consistent with the World Health Organization's (WHO) medical eligibility requirements. (author's)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2005 Oct; 99(10):721-726.There is only a decade remaining in which to attain the United Nations Millennium Development Goals (MDG). These goals have the unprecedented support of 189 nations and are a mechanism for holding rich and poor nations accountable for global development. Three of the eight goals are directly concerned with health outcomes, as are eight of the 18 targets. Those directly concerned with health are not comprehensive (for example, they do not include injuries or reproductive health issues), but they address many key development challenges. However, improved health would contribute to the attainment of all the goals, because ill-health retards development in many ways. For example, catastrophic health expenditure increases poverty, ill-health among family members and children impedes both economic productivity as well as the achievement of universal primary education, and environmental sustainability underpins future prospects for health. (excerpt)
Reaching communities for child health and nutrition: a proposed implementation framework for HH/C IMCI.
Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 2001.  p. (USAID Contract No. HRN-C-00-99-00007-00; USAID Contract No. FAO-A-00-98-00030-00)The Household and Community component of IMCI (Integrated Management of Childhood Illness) was officially launched as an essential component of the IMCI strategy at the First IMCI Global Review and Coordination Meeting in September 1997. Participants recognized that improving the quality of care at health facilities would not by itself be effective in realizing significant reductions in childhood mortality and morbidity because numerous caretakers do not seek care at facilities. Since that first meeting, several efforts were undertaken to strengthen interagency collaboration for promoting and implementing community approaches to child health and nutrition. (excerpt)
Listening to those working with communities in Africa, Asia, and Latin America to achieve the UN goals for water and sanitation.
Geneva, Switzerland, WSSCC, . 80 p.The traditional top-down methods for providing water and sanitation services in poor communities of the developing world have not been successful in reaching out to all. Despite decades of effort and billions of dollars, 1 billion people still lack safe water and almost 2.5 billion lack safe sanitation. The time has therefore come to re-orient national and international efforts in support of a different approach. ‘LISTENING’ is about that new approach. It is an approach which has learnt from the failures of the past and begun to achieve well-documented successes of its own. But it is an approach that is not yet universally accepted because of the many vested interests that stand in its way. In brief, decentralisation and empowerment of people and communities to enable them to take more control of their own lives and to support them in achieving their own development goals must be the method and the aim. But this does not mean that the responsibility to mobilise additional resources for the poor, and to create an enabling environment within which they can move forward, should be abandoned. In fact the responsibility for initiating and supporting community-led approaches means an even greater and more demanding role for government. ‘LISTENING’ attempts to bring these lessons – through the voices of many of those who have been most closely involved – to a wider international audience. (excerpt)
[The role and responsibility of volunteers in context of APFs] Papel e responsabilidade dos voluntarios no contexto das APFs.
Sexualidade e Planeamento Familiar. 2001 Jan-Jun; (29-30):37-9.The International Planned Parenthood Federation (IPPF) is considered the primary organization in the world in the area of sexual and reproductive health, however, potential donors have viewed it as too rigid. The IPPF organized a task force to confront this charge and come up with recommendations for improvement. Their proposal was that IPPF should be comprised of a diverse collection of volunteers in terms of age, sex, socioeconomic origin, occupation, performance, race, creed as well as linguistic and geographical representation in such a way that this can represent the communities in which they function.
Community-based distribution (CBD) of low cost family planning and maternal and child health services in rural Nigeria (expansion).
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (NGA-02)A community-based distribution (CBD) project has been in operation since 1980 in Oyo State, Nigeria. As a result of word-of-mouth communication among health professionals, television coverage of graduation ceremonies, and positive political feedback from the pilot area, the state government requested assistance in expanding the program. In collaboration with the State Health Council, the Pathfinder Fund, University College Hospital, and the Center for Population and Family Health of Columbia University, the program was expanded in 1982 at a cost of US $237,517. In each of the 4 health zones of the expansion area, a Primary Health Center (PHC) became the training and supervisory center. The expanded program was modified in light of experience in the pilot area. Monthly stipends to CBD workers were eliminated and, because of government policy, no fees were to be charged for services. (This policy was later reversed.) Also, a full-time CBD supervisor was assigned to each zone, rather than relying on individual maternity staff members for supervision. Each zone was limited to 100 CBD workers. Data collection included baseline and post-intervention knowledge, attitudes, and practice surveys and a village documentation survey to estimate the service population. The project also carried out in-depth CBD worker interviews, structured observations of training, mini-surveys, analyses of supervision records and service statistics, and a case study of the impact of the CBD program in which villagers were interviewed about the educational and clinical roles of the CBD workers. Although initial family planning (FP) acceptance was low, ever use of a modern method has increased from 2 to 25% in the pilot area. About half of the married women of reproductive ages in the project area are not sexually active at any one time because of postpartum abstinence. Most of the acceptance of modern contraceptives replaces use of traditional abstinence. Male promoters have proved to be an asset to male acceptance of FP services. Individual monetary incentives are not required to motivate CBD workers; however, once incentives are given, difficulties are created if they are stopped, as they were in the pilot area. The CBD approach has changed the concept of health care from that of providing services to clients who come to a fixed site to reaching out to provide services to all people living within a particular catchment area. The expanded project was subsequently extended into additional areas of Oyo State by the State Health Council. In addition, a conference to discuss the project, held in January 1985, was attended by health program managers and policymakers from all parts of Nigeria. The conference stimulated planning by State and Federal Ministries of Health to undertake CBD as a major strategy for primary health care in rural areas.
Guidelines for the trainers of community health workers on the treatment and prevention of acute diarrhoea.
Geneva, Switzerland, WHO, 1980. 29 p.Guidelines to help trainers of community health workers in teaching simple methods and procedures for treatment of acute diarrheal disease are presented. The material is divided into 3 sections: a description of the problem of diarrhea including its causes and dangers; a discussion of treatment including patient assessment, treatment plans for infants and young children, methods of feeding children with diarrhea, treatment plans for older children and adults, medicines for diarrhea, and reporting of cases; and a discussion of prevention of diarrhea covering food and feeding practices, water, and hygiene. The important topics recommended for discussion during training and a list of essential information are included in each section. The information in the guidelines is general and requires adaptation to local cultures and to the particular role of the community health worker in the national health program.
SEXUAL HEALTH EXCHANGE. 1998; (3):5-6.The Family Planning Association of Kenya (FPAK), together with the Population Council's Africa Operations Research/Technical Assistance Project I, developed a program in rural coastal Kenya to gain insight into the relative effectiveness of reaching men with family planning services. The program sent trained teams of men only, women only, and both sexes to 3 comparable sites in Kilifi District, Coast Province, an area with a contraceptive prevalence lower than the national average, to reach out to men in places where they tend to congregate, and to include them in family planning discussions during home visits. The community-based agents were local people recommended by community leaders and aged 30-40 years, married with children, and with at least primary school educations. The agents were trained in a 10-day course and the fieldwork program lasted 18 months. Subsequent program evaluation determined that husband-wife communication on family planning improved in all 3 sites, with the most communication between spouses occurring in the program with both male and female agents. The all-male team distributed the most condoms and also did well distributing female methods such as foam tablets and oral pills. The most reported behavior change among men in response to AIDS education was a move toward having sex with only one's wife. Some concern was expressed, especially among men, about male agents making home visits and men were more likely to respond to educational activities when they were specifically targeted to men. Men also reported greater current use of modern contraceptive methods than women and a major positive change in behavior in response to HIV/AIDS education.