Village Health Committees Drive Family Planning Uptake

This report describes the role of the Village Health Committees (VHCs) of rural Guinea and their partnership in increasing contraceptive availability and acceptance as a means to child survival through a Save the Children project funded by United States Agency for International Development (USAID). Save the Children and its partner non-governmental organisations (NGOs) tackled contraceptive availability with such activities as training community-based distributors (CBDs) in each participating village and adding family planning promotion to the job description of every VHC member.

Save the Children’s work on child survival in this region where women bear an average of 7.4 children during their lifetimes was designed to reduce the principal causes of child and infant mortality by offering an intervention mix that included maternal and newborn care, nutrition and micronutrients, HIV/AIDS prevention and treatment, and immunisation. With additional USAID funding, the organisation aimed to improve the use of modern family planning services with special attention to women with children under 2 years. This document highlights the VHCs' role.

The VHCs' primary purpose was threefold: (1) to forge a link of ownership and responsibility between the community and the health system; (2) to increase the community’s demand for and use of quality health services including family planning; and (3) to increase the health system’s ability to provide such services in a way acceptable and accessible to the local population. The VHCs were composed of seven to nine members, each a permanent resident of his or her village and respected by the community as a whole, typically district chiefs, Imams, village elders, representatives of traditional health workers (e.g., healers and birth attendants), and a traditional communicator (the oral historian known as a griot).

VHCs, as stated here, were leaders in changing people’s attitudes and access to family planning. The committees also address family planning acceptability. Two types of VHC members had a particular bearing on making family planning accessible and acceptable: CBDs and religious leaders. For example, male and female CBDs - via in-home visits and outreach clinics - made birth spacing a topic not only for women and health workers, but also for couples and communities. CBD duties included health education sessions with groups and individuals to recruit new clients and monthly follow-up visits with existing clients. They also engaged in advocacy sessions with religious leaders; participated in monthly health centre meetings to review education activities, sales, referrals, and resupply commodities; and attended in-service trainings as needed.

Each VHC had a religious leader - typically a village Imam - as a member. This was an essential element in an area where some religious leaders renounced birth spacing and family planning as practices opposed to Koranic teachings. Save the Children and its partners offered a 3-day training to these men to learn basic family planning information; Guinean policies related to family planning; the relationship between Islam, family planning, and reproductive health (especially as referred to in the Koran); and their role and responsibilities in family planning promotion. Attendees created an action plan, including ways to introduce family planning information during sermons, discuss the topic during community consultations and meetings with mosque councils in each village, and orient their peers to the topic and to Koranic verses that pertain to women’s health including supportive use of birth spacing and men’s responsibility vis-à-vis their families.

Each VHC developed and followed a work plan of promotional activities, such as awareness-raising sessions, group discussions, nutritional demonstrations, and baby weighing. To supplement this work, regular outreach clinics brought health workers to villages to offer child immunisations, antenatal care, and family planning information and methods. The VHC acted as the health services’ local liaison, informing villagers of the clinic date, organising the service site, seeking out those lost to follow-up, and encouraging women and men to attend. The VHC maintained outreach clinic records including contraception promotion and sales, home visits, events, cases of disease, and pregnancy progress reporting. It included sanitation compliance observations and other health-related data collection. Monthly assemblies allowed the VHC to discuss changes in health information with villagers and allowed villagers to debate and discuss the adoption of new behaviours and use of new services. The VHC became partners in the district health and administrative structures, organising and implementing outreach strategies, providing data, integrating their trained birth attendants into clinic auxiliary staff, arranging transportation agreements for birthing emergencies, and establishing emergency loan funds for emergency obstetric care (EmOC) and contraceptive purchase.

Key findings from project evaluations show that the contraceptive prevalence rate increased substantially among women with children under 2 years. The use of modern family planning methods by mothers not wanting another child in the next 2 years rose. Almost three-quarters (73%) of women in Mandiana and Kouroussa spaced their last two pregnancies by at least 24 months. In all villages, Imams - many of whom were once opponents of family planning - talked about birth spacing via breastfeeding and oral/injectable contraceptives in their mosques. In some cases, the children or siblings of Imams became CBDs. CBDs - 225 women and 225 men - were trained in family planning policies and promotions, sales, referrals, sexually transmitted infections and HIV/AIDS, and improving relations with health facility workers. Villages without health facilities benefited from the family planning component as much as those with health facilities because of the presence of VHCs and their CBDs. Villages with access to family planning services almost doubled over 5 years. In addition, the VHC in Mandiana district successfully piloted a reintroduction of the intrauterine device (IUD).

The document concludes that VHCs increased the villages’ sense of having a stake in health services and the health services’ sense of duty to those they serve. "The VHC... ensured that family planning information and selected services moved beyond the domain of the health facility and into communities and homes....This model created a functional bond between the professionals and managers of health and the community forces. All [stakeholders including the district health services] recognize the importance of these new partners for the achievement of project success."