Reaching poor and underserved groups is a goal of many community health worker programs, but whether or not they are effective in reaching this goal is not clear. There is also little evidence on effectiveness of integrated programs in which community health workers are asked to provide multiple services, which has been an increasing trend in recent years. The Strengthening Communities Though Integrated Programming project in Nampula province of Mozambique, which is led by Pathfinder, trains community health workers to provide integrated services including family planning.
In 2012, Pathfinder conducted a study in SCIP project areas to explore whether community health workers who provide an integrated package of services communicate with beneficiaries about family planning, and what actions women take based on these messages. The study also explored whether community health workers are reaching the poor, marginalized and vulnerable, and examined the costs of implementing the community health worker component of the SCIP project. The findings showed that rates of contact with community health workers were relatively high in SCIP project areas, and some sociodemographic and household characteristics were significantly associated with contact with a community health worker (living in informal union, household education and assets).
The study also found that community health workers can successfully convey family planning information as part of a package of integrated services and a substantial proportion of women receiving the messages do discuss family planning with their spouses or friends and/or adopt contraception. The results of the costing analysis showed that using community health workers to deliver integrated services can be relatively cost-efficient compared to other community-based programs in relation to specific outputs (cost per capita, cost per household covered and cost per beneficiary served).