Evaluation of a volunteer community-based health worker program for providing contraceptive services in Madagascar

Contraception. 2013 Nov;88(5):657-65. doi: 10.1016/j.contraception.2013.06.008. Epub 2013 Jun 15.


Background: Madagascar recently scaled up their volunteer community health worker (CHW) program in maternal health and family planning to reach remote and underserved communities.

Study design: We conducted a cross-sectional evaluation using a systematic sample of 100 CHWs trained to provide contraceptive counseling and short-acting contraceptive services at the community level. CHWs were interviewed on demographics, recruitment, training, supervision, commodity supply, and other measures of program functionality; tested on knowledge of injectable contraception; and observed by an expert while completing five simulated client encounters with uninstructed volunteers. We developed a CHW performance score (0-100%) based on the number of counseling activities adequately met during the client encounters and used multivariable linear regression to identify correlates of the score.

Results: CHWs had a mean performance score of 73.9% (95% confidence interval [CI]: 70.3-77.6%). More education, more weekly volunteer hours, and receiving a refresher training correlated with a higher performance score. We found no other associations between measures of the components previously identified as essential for effective CHW programs and performance score.

Conclusions: Although areas of deficiency were identified, CHWs proved capable of providing high-quality contraception services.

Keywords: Community health workers; Contraception; Evaluation; Multivariable linear regression.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Clinical Competence
  • Community Health Workers* / education
  • Contraceptive Agents, Female / administration & dosage
  • Cross-Sectional Studies
  • Developing Countries
  • Drug Implants
  • Family Planning Services* / education
  • Female
  • Health Services Accessibility*
  • Humans
  • Inservice Training
  • Madagascar
  • Male
  • Middle Aged
  • Patient Education as Topic
  • Program Evaluation
  • Quality of Health Care*
  • Volunteers* / education
  • Workforce
  • Young Adult


  • Contraceptive Agents, Female
  • Drug Implants