Meet the community health workers

For people living in Sierra Leone, the first source for health information is often a Community Health Worker. 

These trusted community members, appointed by local leaders, are easier to contact than local health facility staff—and they’re highly motivated to improve the health of their community. But they have to cover a wide range of health topics, and they don’t always have enough training on sexual and reproductive health. 

That’s why we recently worked with community health workers to develop new tools they can use in discussions about contraception. The result? More women chose long-acting reversable contraceptives—and we learned some important lessons about how to implement tools like these in the future.  

New tools for community health workers 

MSI Sierra Leone worked with community health workers to develop four new tools to guide their conversations about contraception in the community: 

• A flip chart to use during discussions to explain the links between contraception and other health topics  
• A myth-busting card game, exploring common questions related to sexual and reproductive health 
• A package of a few household items for engaging community leaders to raise awareness for the services and advice available  
• An ‘ask us anything’ anonymous question box, to help tailor community health workers’ information sessions 

By training community health workers to use the tools, we strengthened their ability to discuss contraception. Health workers also got support reaching parts of the community that had been left out. The goal of all these conversations? A positive community dialogue around contraception use. 

Evaluating the new tools and training  

The new resources were piloted with 50 community health workers, working with 17 public health facilities across four regions of Sierra Leone. In October of 2023, we kicked off the project with regional training sessions. The project ran through March 2024. 

From the start, we got positive feedback from health workers and public sector healthcare providers. One told us, “The tools help to increase family planning uptake and acceptance because it builds confidence in community health workers so then the community have more confidence in them.” 

But would these tools actually increase contraceptive uptake? To evaluate their effectiveness, we used several methods, including: 

• Pre- and post-training surveys of participating health workers 
• Informal interviews with community stakeholders, including health facility teams 
• Analyzing service data from pilot and non-pilot facilities across all four regions 

What we found 

Before the training, many community health workers felt pretty confident talking about long-acting reversible contraceptive methods—but pre- and post-training surveys show they still had plenty to learn. Average scores for knowledge on contraception increased from 2.3 out of 5 pre-pilot to 3.5 out of 5 post-pilot. Armed with more complete knowledge, health workers felt more confident talking about contraception after the training.  

When we asked about the tools themselves, community health workers described how the flipchart, card game, and question box enabled them to build their knowledge of contraception, talk about the links between contraception and other topics, and dispel common myths. 

But did these improvements actually convince women and girls to use a contraceptive method? Results were somewhat mixed. We saw small increases in client visits across all pilot sites, compared to the period before the pilot. But the most striking improvements happened in two locations: An 18% increase in client visits in Bonthe, and a 48% increase in Bombali. 

So what was different in those two regions? In Bonthe and Bombali, the Ministry of Health and Sanitation was more involved in the project—and their buy-in made a real impact.  

Even where client visits didn’t increase so dramatically, the pilot had an effect. Couple years protection – a measure of how many years a couple is protected by the contraceptive they chose – increased 52% across all sites. This reflects more women choosing a long-acting method. 

What this means for community health workers

When community health workers are the first point of contact for health information, it’s important that they have the tools and training they need to discuss contraception. We found that simple tools can help health workers feel more confident and informed discussing contraception, leading more women to choose a long-acting reversible contraceptive method.  

But to really have an impact, just offering the tools and training health workers isn’t enough. Broader government buy-in and support makes a difference. When the Ministry of Health and Sanitation at the district level and the teams at local health facilities are included in, and supportive of, new resources, it helps community health workers reach more women with the information they need.  

Since the pilot, MSI Sierra Leone has continued working with government partners to support community health workers making a difference in their communities. By equipping health workers with knowledge about contraception, we can help the public health system reach women and girls with the tools to control their own futures.