Experiences engaging community health workers to provide maternal and newborn health services: Implementation of four programs

A paucity of skilled health providers is a considerable impediment to reducing maternal, infant, and under-five mortality for many low-resource countries. Although evidence supports the effectiveness of community health workers (CHWs) in delivering primary healthcare services, shifting tasks to this cadre from providers with advanced training has been pursued with overall caution-both because of difficulties determining an appropriate package of CHW services and to avoid overburdening the cadre. We reviewed programs in Rwanda, Afghanistan, Nigeria, and Nepal where tasks in delivery of health promotion information and distribution of commodities were transitioned to CHWs to reach underserved populations. The community-based interventions were complementary to facility-based interventions as part of a comprehensive approach to increase access to basic health services. Drawing on these experiences, we illuminate commonalities, lessons learned, and factors contributing to the programs' implementation strategies to help inform practical application in other settings.