Status of CBD in Africa: Evidence from Mali

1
Status of CBD in Africa Evidence from Mali
Seydou Doumbia Diouratie Sanogo Ayo Ajayi John
W. Townsend
2
Context of Family Planning in Mali

• Population 11.3 million, nearly half below 15
  years of age
• TFR of 6.7 and 3 growth rate
• With 70 of population rural, access to basic
  health services is limited ( 20)
• HIV adult infection - 1.7

3
Milestones in the National Program

• 1980 Founding of Family Health Division
• 1989 First CBD effort in 54 villages
• 1991 Explicit population policy
• 1994 Established National Family Planning
  Program DRH
• 2003 Strategic Development Plan

4
Contraceptive Prevalence in Mali (DHS)
5
Reasons for Non-Use of Family Planning Among
Married Women (DHS, 1996)
6
Results of CBD Pilot 1989-92
7
CBD Programs in Mali

• Public CBD program since 1990, with 44 percent of
  all CBD agents
• 13 NGOs support CBD networks
• Public supervisors are nurses, while NGO
  supervisors more diverse
• Ratio of supervisors to agents - 15 to 170
• Weak public-private collaboration

8
Roles of CBD Agent

• Inform and educate rural communities for behavior
  change
• Sale (75) and/or distribute (25) contraceptive
  methods
• Refer clients to health centers
• Coordinate with Community Health Associations
  (ASACO)

9
Geographic Coverage of CBD by Region
Region CBD Agents Villages Covered Coverage
Kayes 284 164 11
Koulikoro 1824 890 46
Sikasso 914 587 34
Segou 566 240 11
Mopti 395 188 9
Total 4179 2069 22
10
Profile of CBD Agents

• More than 50 of CBD agents are men
• Median age for both men and women is 35 or above
• Most are married, half of women in polygamous
  relationships, and have basic education (1st and
  2nd cycle)
• Principal income from agriculture, although women
  involved in commerce

11
Recommendations for Improving CBD Program

• Expand effective coverage of national program
• Reinforce link between agents and ASACO and other
  community groups
• Reinforce supervision of agents
• Reinforce logistic supply for CBD agents

12
Further Recommendations

• Experiment with alternative strategies for
  motivation
• Test innovative services for men and youth
• Experiment with dual protection strategy
• Evaluate impact of child survival activities in
  CBD program

13
Looking to the Future

• Disseminate findings to key audiences
• Review priority tasks and information used for
  management
• Strengthen related operational policies and
  financing
• Improve quality in existing care networks and
  related commercial services