Community Based Distribution of Family Planning

Community Based Distribution of Family Planning Basics of Community-Based Family Planning

Community Based Distribution: Where is the CBD approach useful? i.e. Where does it make sense to use this approach as opposed to a different service delivery approach.

Community Based Distribution: History • Significant program experience in Asia, Latin America and Africa over the last decades. • Has had demonstrative impact in increased use of FP methods particularly where unmet need is high, where access is low, and where there are social barriers to use of services. • CBD strategy has increased the acceptability of modern methods.

Community Based Distribution: CBD Can Increase Use of FP • Immediate increase as agents legitimize FP and increase access • More methods provided increases overall CPR • Increase in use may take time due to building new social norms • CBD can augment clinic-based quality improvements

Community Based Distribution: Why choose this strategy? • Effective in early stages of introducing FP services (in areas of large unmet need, low awareness of FP, and poor access). • Addresses social and geographical barriers (helps generate more demand for FP, increase use of FP, and sustain use of FP). • Potential for addressing the needs and service gaps identified (including responding to other basic health needs).

Community Based Distribution: Why choose this strategy? • Can be a strategy to reach men (increase couples communication), and youth. • Can be a strategy to increase program coverage to other populations/intervention areas. • Community response is positive - services are appreciated, convenient, easy to access, active listening from CBD. • It is a strategy that includes a lot of community participation/ownership.

Community Based Distribution:When should this strategy be considered? • When use of FP is less than 25%. • When there is low knowledge of FP services in the intervention area. • When population has limited access to clinics. • When there are barriers to use of services. • When CBD strategy supports government goals and objectives. • When there is organization capacity to include this strategy in FP or health programming.

Community Based Distribution: Reasons for not choosing this strategy • When there is high awareness and knowledge of FP, combined with 45-50% use of modern contraceptives. • May not be necessary if there are alternative means of increasing access to services. • If CBD use of injectables is not supported by MOH; can’t meet demand for long acting and permanent methods.

Community Based Distribution: Reasons for not choosing this strategy • Challenging to assure service quality and continuity of volunteers. • Requires significant commitment in time and resources. • Success and cost-effectiveness are highly variable. • Tend to be small programs with little impact on overall CPR unless it is a national effort.

Community Based Distribution: Program Elements What elements go into CBD programming? (group contribution)

Community Based Distribution: Program Elements • Data gathering for decision making (review opportunities and obstacles for CBD). • Community participation and volunteer selection (process and criteria are key). • Training (traditional, on the job, phased- out, focused on specific groups). • Supervision (supportive, selective).

Community Based Distribution: Program Elements • Targeting potential users (ELCO, MWRAs). • Contraceptive supplies and system for getting supplies. • Coordinate with and reinforce existing FP and health services. • Integration with other strategies and interventions.

Community Based Distribution: Program Elements • CBD Motivation (sustainable and effective incentives). • Management Information system (info. users, info. needed, how info. will be used). • Monitoring and Evaluation (agent performance, program results).

Community Based Distribution: Program Elements • Preparedness for CBD replacement (regular need for training). • Preparedness for potential problems.

Community Based Distribution: Planning/Decision making • Intervention area (how big), and how many CBD agents to ensure coverage. • CBD program model to follow (government, NGO, voluntary, salaried, allowance, commission, male, female, home visits, depot/post). • Program staff (existing or new). • Expanding existing efforts or initiating new ones.

Community Based Distribution: Planning/Decision Making • Assuring ongoing training and supervision. • Assuring re-current costs and support. • Potential for cost recovery. • Donor support (who and for how long). • Donor program requirements.

Community Based Distribution: Elements contributing to success What elements contribute to the success of CBD approach? (group contributions)

Community Based Distribution: Elements contributing to success • Focusing on social factors as well as technical aspects. • Community involvement. • Volunteer motivation/incentive plan. • Making use of existing networks. • Political will and support. • Broad service regimen, and evolving program as RH situations evolve.

Community Based Distribution: Elements contributing to success • Training is competency-based, incremental and practical. • Supervision is supportive. • Data and feedback provide motivation and credibility. • Integration of evaluation into structure of program so it occurs continuously and at different levels.

Community Based Distribution: Elements which threaten success What elements threaten the success of a CBD approach? (group contributions)

Community Based Distribution: Elements which threaten success • Failure to recognize the effort and resources required for CBD program. • Failure to capitalize on opportunities and potential for broadening interventions. • Pre-mature emphasis on sustainability and cost recovery before demand is adequately established.

Community Based Distribution: Elements which threaten success • Failure to address quality of care issues. • Lack of support & commitment from MOH at district and facility level. • Isolation of CBD (limited contact, support, supervision) • CBD job responsibilities may be too broad. (difficult to manage, reduce focus on FP).

Community Based Distribution: Challenges • Distribution of injectables in Africa (obstacles). • Distribution of emergency contraception (WHO endorsed). • Reaching youth and men. • Client concern with confidentiality.

Community Based Distribution: Challenges • Policies on para-medicals dispensing of medication (such as depo-provera or in the case of broadening CBD role to include treatment of simple, common illness). • Lack of evidence of added value of using CBD for other services. • Sustainability (community/volunteer motivation, client load, diversification of program role, financial support).

Community Based Distribution: Why is CBD a Repositioning Strategy for FP? • Fertility preferences still high. • Interest in using FP to space or limit births still low. • Access by certain populations is still low (married adolescents, hard to reach groups, people in conflict-affected settings).

Community Based Distribution: Why is CBD a Repositioning Strategy for FP? • Changing these social norms requires education and discussion at individual, family and community level. • Clinic-based services cannot easily stimulate or facilitate such social interactions. • Kenya example: Reduced support of CBD nationwide - drop in CPR.

Community Based Distribution: Recommendations • Pilot test model first to identify what is working/what isn’t. • Plan for going to scale from the beginning. • Use existing community level workers rather than develop new cadre. • Work with service providers.

Community Based Distribution: Group Work Case Studies

Community Based Distribution: Project/Country Group Work: • Why or why not CBD? • Where are we in the process of implementing community-based family planning programs? • What needs to be done to strengthen our CBD and/or other community strategies?

Community Based Distribution of Family Planning