World Health Organization · 1st edition, 2025 · 66 pages
Evidence-based strategies for policy-makers and programme managers to expand contraceptive access through task sharing
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Policy-makers and programme managers in ministries of health, health facilities, NGOs and other implementing bodies
- Evidence
- Narrative review of 55 peer-reviewed studies; systematic reviews; WHO normative guidance; expert consensus from WHO task sharing technical working group
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO guidance provides evidence-based strategies for planning, implementing and scaling up task sharing for contraceptive services. Task sharing – the rational redistribution of responsibilities among health workforce teams – enables less specialized health workers to safely provide specific contraceptive methods, thereby addressing critical workforce shortages and expanding access to family planning services.
The guidance outlines which health worker cadres can safely provide which contraceptive methods, based on a large body of evidence demonstrating the safety and effectiveness of task sharing. For example, auxiliary nurses can safely insert and remove implants, community health workers can provide condoms, pills and injectables, and women can self-inject DMPA-SC. The document presents four core strategies: advocacy and stakeholder engagement; landscape analysis and planning; task sharing implementation; and monitoring and quality assurance at scale.
Implementation requires comprehensive training, supportive supervision, functioning referral systems, appropriate remuneration and quality assurance mechanisms. Modelling estimates that fully implementing WHO task sharing recommendations could reduce contraceptive service delivery costs by 28% – or $1.6 billion – across 128 low- and middle-income countries. The guidance includes practical tools, templates and country case studies from Kenya, Malawi, Nigeria, Pakistan and Senegal.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Community health workers can safely provide condoms, pills and injectable contraceptives (DMPA-IM, DMPA-SC, NET-EN)
- Auxiliary nurses and auxiliary nurse-midwives can safely insert and remove contraceptive implants with targeted monitoring and evaluation
- Nurses, midwives and auxiliary nurse-midwives can safely insert intrauterine devices (IUDs)
- Associate/advanced associate clinicians can safely provide vasectomy and tubal ligation procedures
- Women can self-administer DMPA-SC (subcutaneous depot medroxyprogesterone acetate) with appropriate training and support
- Pharmacists and pharmacy workers can provide injectable contraceptives (administering injections is within their typical scope of practice)
- All task sharing requires task-specific training, functioning monitoring and supervision systems, and established referral pathways
- Implementing WHO task sharing recommendations could reduce service delivery costs by 28% ($1.6 billion) across 128 low- and middle-income countries
WHO recommendations for task sharing in contraceptive services by cadre and method
Table extracted from the guideline
| Contraceptive method/service | Self-user | Lay health workers | Pharmacy workers | Pharmacist | Auxiliary nurse | Auxiliary nurse/midwife | Nurse | Midwife | Associate/advanced associate clinicians | Non-specialist doctors | Specialist doctors |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Products and methods for self-use (oral contraceptive pills, emergency contraception, male and female condoms, DMPA-SC, DMPA-IM) | R | — | — | — | — | — | — | — | — | — | — |
| Injectable contraceptives (DMPA-IM, NOR-EN) or combined injectables | — | R | R | R | R | R | R | R | R | R | R |
| Implant insertion and removal | — | — | — | — | R | R | R | R | R | R | R |
| Intrauterine device (IUD) | — | — | — | — | — | R (in specific circumstances) | R | R | R | R | R |
| Tubal ligation (female sterilization) | — | — | — | — | — | — | — | — | R (in specific circumstances) | R | R |
| Vasectomy (male sterilization) | — | — | — | — | — | — | — | — | R (in specific circumstances) | R | R |
| Lactational amenorrhea method and fertility awareness | R | R | — | — | R | R | R | R | R | R | R |
Source: World Health Organization, Guidance on planning, implementing and scaling up task sharing for contraceptive services. Reproduced in summary form.
What changed in this edition
Versus the previous edition
- Added DMPA-SC (subcutaneous depot medroxyprogesterone acetate) as a contraceptive method based on 2023 systematic review evidence
- Added self-user as a cadre category for self-administration of DMPA-SC and DMPA-IM (in specific circumstances)
- Incorporated 2022 WHO guidelines on self-care interventions and 2022 abortion care guideline recommendations
- Consolidated previous 2017 task sharing recommendations with updated evidence from 55 peer-reviewed studies
From the guideline
Verbatim
“Task sharing aims to achieve rational and optimal distribution of responsibilities among health teams. Specific tasks are shared, where appropriate, with less specialized health workers to make more efficient use of the available personnel.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As a health systems consultant, I see task sharing for contraceptive services as directly relevant to Georgia's Universal Health Coverage programme and our broader efforts to strengthen primary health care. The most actionable recommendation for Georgian clinicians and policy-makers is that auxiliary nurses can safely insert and remove contraceptive implants and IUDs with proper training and supervision – this could immediately expand access in our rural regions where obstetrician-gynaecologist shortages persist. However, implementation will require careful navigation of our professional regulatory environment; the Georgian Medical Association and nursing regulatory bodies would need early engagement to update scopes of practice, and initial piloting in selected rural primary care facilities with rigorous monitoring would build the local evidence base needed for national scale-up. The guidance's emphasis on appropriate remuneration for cadres assuming new responsibilities is critical – without addressing this, we risk creating unsustainable volunteer-dependent programmes.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance offers a cost-effective strategy to address geographic inequities in contraceptive access, particularly in rural areas where provider density is lower. Countries in the region considering Universal Health Coverage expansion should assess whether current regulations permit task sharing (e.g., whether auxiliary nurses can provide implants or IUDs, whether pharmacists can administer injectables). A national landscape analysis would need to map existing cadres against WHO-recommended scopes of practice, review professional regulatory frameworks, assess community health worker programmes if they exist, and evaluate the current modern contraceptive prevalence rate and method mix. Eastern European countries typically have physician-centred service models, so policy change, professional association engagement and phased piloting would be critical first steps before scale-up.
Questions this guideline answers
Quick answers
Which contraceptive methods can community health workers safely provide?
Community health workers (lay health workers with task-specific training but no formal professional certificate) can safely provide condoms, oral contraceptive pills, cycle beads and injectable contraceptives (DMPA-IM, DMPA-SC, NET-EN). Multiple studies confirm this improves contraceptive use with no increase in adverse events when appropriate training, supervision and referral systems are in place.
Can auxiliary nurses insert and remove contraceptive implants?
Yes. WHO recommends that auxiliary nurses and auxiliary nurse-midwives can provide implant insertion and removal with targeted monitoring and evaluation. A study from Nigeria demonstrated that community health extension workers (a type of auxiliary nurse) successfully provided implants with high client satisfaction (>95%), provided adequate training, supportive supervision and quality monitoring are in place.
What training and support systems are required for safe task sharing?
Safe task sharing requires: (1) initial and ongoing task-specific training for providers and supervisors; (2) adequate supplies of drugs and commodities; (3) clear supervisory responsibilities and supportive supervision mechanisms; (4) functioning referral pathways for complications and follow-up; (5) monitoring and quality assurance systems; (6) updated regulations, protocols and curricula supporting the cadre's new scope of practice; and (7) appropriate remuneration reflecting the expanded responsibilities.
How much can task sharing reduce contraceptive service delivery costs?
Modelling using the Guttmacher Institute's Adding It Up model estimates that fully implementing WHO task sharing recommendations would reduce contraceptive service delivery costs by 28% – approximately $1.6 billion – across 128 low- and middle-income countries. The largest cost savings come from task sharing male condom provision ($600 million), contraceptive pills ($500 million), injectables ($326 million) and IUD provision ($133 million). Initial investment is required for training and system strengthening, but cost savings are realized at scale.
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- Issuer
- World Health Organization
- Type
- Guidance (normative)
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-06-27
- Languages
- English
- Scope
- Global; low- and middle-income countries with health worker shortages and unmet need for contraception
- Audience
- Policy-makers and programme managers in ministries of health, health facilities, NGOs and other implementing bodies
- Pages
- 66
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-011148-6
- Evidence
- Narrative review of 55 peer-reviewed studies; systematic reviews; WHO normative guidance; expert consensus from WHO task sharing technical working group
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
World Health Organization. Guidance on planning, implementing and scaling up task sharing for contraceptive services. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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