Community Based Distribution of Family Planning

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

3
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.

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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

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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).

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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.

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Community Based DistributionWhen 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.

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Community Based DistributionWhen 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.

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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 cant meet demand for long acting and
  permanent methods.

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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.

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Community Based Distribution Program Elements

• What elements go into CBD programming?
• (group contribution)

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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).

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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.

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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).

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Community Based Distribution Program Elements

• Preparedness for CBD replacement (regular need
  for training).
• Preparedness for potential problems.

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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.

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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.

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Community Based Distribution Elements
contributing to success

• What elements contribute to the success of CBD
• approach?
• (group contributions)

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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.

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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.

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Community Based Distribution Elements which
threaten success

• What elements threaten the success of a CBD
• approach?
• (group contributions)

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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.
  

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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).

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Community Based Distribution Challenges

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

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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).

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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).

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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.

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Community Based Distribution Recommendations

• Pilot test model first to identify what is
  working/what isnt.
• Plan for going to scale from the beginning.
• Use existing community level workers rather than
  develop new cadre.
• Work with service providers.

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Community Based Distribution

• Group Work
• Case Studies

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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?