Accepted for/Published in: JMIR Research Protocols
Date Submitted: Aug 1, 2025
Date Accepted: Oct 31, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Improving Access to Family Planning Services through Community Health Extension Workers: Protocol for Evaluating a Community-Based Implant Provision Pilot Project in Uganda
ABSTRACT
Background:
In Uganda, 22% of all women of reproductive age have an unmet need for family planning services. Access to contraceptive services, especially long-term reversible contraceptives like implants remains a challenge. The numbers of properly trained health providers are also not sufficient to address the needs for contraception. The Uganda Ministry of Health implemented a community-based implant provision pilot project where community health extension workers (CHEWs) were trained and accredited to insert implants at community level.
Objective:
This study therefore intends to evaluate the implementation and acceptability of stakeholders towards task shifting the provision of family planning implants to CHEWS in Uganda.
Methods:
The evaluation will employ a cross-sectional design using both quantitative and qualitative methods. The quantitative component will employ a non-inferiority design while the qualitative component will employ a descriptive approach. The non-inferiority design involves a comparison of the competence of the currently authorized cadre to offer the service to the proposed cadre (CHEWs). Compared with a randomized controlled trial, the non-inferiority design is more appropriate for this evaluation because the CHEWS and the authorized cadre are not comparable in terms of level of training and competencies. The authorized cadre have gone through formal training which is not comparable with the training the CHEWs have received and so the comparison is such that the competencies of the CHEWs are non-inferior or at most, equal to the competencies of the authorized cadre. Quantitative data will be collected among 184 selected CHEWs using performance assessment checklists and practice-based questionnaires that were developed based on the training manuals. Competency will be measured on a continuous scale and summarized as mean scores. Qualitative data will be collected through key informant interviews (n=23), in-depth interviews (n=24) and focus group discussions (n=18). Qualitative data will be analyzed using thematic analysis following the framework method for the analysis of qualitative data using ATLAS ti Version 9.
Results:
Preliminary findings indicated improved confidence and capacity of community health workers to provide implants in spite of challenges such as poor waste disposal, record keeping and data management. At the time of publication, training of research assistants had been concluded and data collection had started. Final results will be published in 2026.
Conclusions:
This pilot will generate contextual information that can be used to improve access to family planning services at community level.
Citation
