Community-based family planning (CBFP) brings family planning information and methods to women and men in the communities where they live rather than require them to visit health facilities. Four CBFP strategies have been proven to extend services into the community: community-based distribution (CBD), community depots, mobile services, and engaging the private sector. Several cross-cutting themes emerge with all four CBFP strategies, including involving the community in the CBFP program, building interest in the CBFP program and changing family planning behaviors, and ensuring reliable access to commodity supplies. These cross-cutting themes are addressed in the Community Mobilization, Behavior Change Communication, and Program Design & Management tabs, respectively.
One of the main objectives of CBFP programs is to increase access to and choice of family planning in underserved areas. Community health workers provide access to a variety of methods, such as oral contraceptives, condoms, and increasingly, injectable contraceptives. They also educate women and couples to use fertility awareness methods such as the Lactational Amenorrhea Method (LAM) and the Standard Days Method (SDM), and can make referrals for clinic-based methods. This holistic approach ensures that clients in the community have access to a range of contraceptive choices to fit their needs.
This section of the CBFP Toolkit is intended to provide users with resources that give overviews and distill lessons learned about CBFP programs, organized largely by the key CBFP strategies:
Have a suggested resource or comment about this section? Please visit our discussion board. We especially welcome suggestions of resources that provide a succinct overview or lessons learned about community depots, mobile services, and private-sector strategies.
This online transparency provides a graphical representation of the potential contribution of community health workers to improved maternal and child health in many parts of the world.
This slide set includes panel presentations on the experiences of Afghanistan, Nepal, and Yemen in expanding community-based access to family planning, including injectables.
This document is a focused bibliography of community-based family planning programs in sub-Saharan Africa. A literature search for peer-reviewed journal articles was conducted in multiple health databases, such as PubMed and Popline. In addition, this bibliography contains review articles on community-based family planning programs and is organized by region and country.
This report describes Pathfinder's efforts at the grassroots level to expand access and knowledge, stimulate acceptance, and create awareness and ownership of reproductive health and family planning programs. It covers some of the lessons learned of what makes community-based programs thrive and provides examples of how these programmatic concepts are integrated into their work.
Lessons learned include:
Community-based distribution (CBD) programs are the optimum way of reaching people in rural areas of developing countries where conventional methods of delivery do not exist or fail. This paper reviews findings and experiences from over 30 years of efforts to implement CBD of family planning methods around the world. Although research suggests that community-based service delivery can contribute to contraceptive use, the magnitude of impact is often in doubt or its existence is questionable when compared to alternative family planning delivery services.
This seminar summarized evidence on the effectiveness, impact, cost, and sustainability of various CBD models; identified best practices in African CBD programs; and described how CBD programs can meet reproductive health needs in sub-Saharan Africa. Key issues reviewed included: effectiveness, cost, and sustainability of CBD programs; distributor selection, training, and supervision; products and services; integration of new services; evaluation of CBD programs; and mobilization of sustainable support. The seminar was attended by participants of the U.S.
This paper reviews findings and experiences from efforts to implement community-based family planning services in sub-Saharan Africa. Although research suggests that community-based service delivery can contribute to contraceptive use, the magnitude of impact is often in doubt or is considerably less than was observed in similar projects in Asia in the 1970s and 1980s. Reasons for the constrained impact of community-based family planning in Africa are reviewed and assumptions about the efficacy and mechanism of community-based distribution (CBD) are discussed.
This issue of The Manager helps reproductive health managers develop solutions to bring services to hard to reach, underserved populations and discusses the kinds of groups that are hard to reach, how to select a group to serve, and methods for determining their reproductive health needs.
This e-learning course focuses on the community-based family planning (CBFP) aspect of a broader community health intervention. The course orients the learner to the major strategies, benefits, and challenges of CBFP and to essential concepts for successful, sustainable programs.
By the end of the course, the learner will be able to:
This presentation gives an overview of community-based distribution, why and when to choose this strategy, and key elements that go into community-based distribution programming.
This document provides strategies for community based distribution of sexual and reproductive health focusing on: financing CBD programmes, agent compensation and motivation, recruitment and training of CBD agents, supervision and management of CBD agents, monitoring CBD impact and effectiveness, quality of care, cost effectiveness, and sustainability.
This report describes Pathfinder's efforts at the grassroots level to expand access and knowledge, stimulate acceptance, and create awareness and ownership of reproductive health and family planning programs. It covers some of the lessons learned of what makes community-based programs thrive and provides examples of how these programmatic concepts are integrated into their work.
Lessons learned include:
This issue of The Manager helps reproductive health managers develop solutions to bring services to hard to reach, underserved populations and discusses the kinds of groups that are hard to reach, how to select a group to serve, and methods for determining their reproductive health needs.
In June 2009, a technical consultation held at the World Health Organization (WHO) in Geneva concluded that evidence supports the introduction, continuation, and scale-up of community-based provision of progestin-only injectable contraceptives. The group of 30 technical and programme experts reviewed scientific and programmatic experience, which largely focused on the progestin-only injectable, depot-medroxyprogesterone acetate (DMPA).
This set of four advocacy briefs is designed to supply decision-makers with information on expanding community-based access to injectable contraception. Drawing on research and programmatic evidence from Africa, Asia, and Latin America, the briefs explain community-based provision of injectables, including the safety and effectiveness of the innovation, and provide an overview of the technical and logistical issues to consider when initiating the practice within existing reproductive health programs.
This literature review details the key findings on the feasibility and acceptability of home delivery of depo-subQ provera 104™ in the Uniject™ injection system (depo-subQ in Uniject). The review focused on self-injection and looked specifically at subcutaneous depot medroxyprogesterone acetate (DMPA) compared to the intramuscular formulation; considerations for home administration of injectable contraception, particularly in low-resource settings; and identified research needs for home administration, including self-injection, of depo-subQ in Uniject.
This document summarizes the results of a literature review conducted to identify research evidence and program experience on interventions designed to expand access to / provision of contraceptive injectables, focusing on non clinic-based services and programs.
The specific objectives of the study were to assess client satisfaction and competence of community-based providers in providing the three-monthly injectable contraceptive depot-medroxyprogesterone acetate (DMPA).
This PowerPoint presentation focuses on community-based distribution of injectable contraception, providing information on:
What the innovation entails
Where this innovation is in use
Data from studies conducted by Family Health International
What should be in place before introduction
Challenges to introduction
How NGOs can implement the strategy
Resources for implementation and advocacy
Injectable contraceptives are an increasingly popular method of family planning because they offer users privacy and convenience. But many eligible women - particularly in rural areas - do not have access to injectable methods, which are usually provided in health facilities. One way to expand access to injectable contraceptives is to train community health workers to provide them. Community health workers in several Asian and Latin American countries have been providing these methods to their clients for years.
The objective of this study was to compare the safety and quality of contraceptive injections by community-based health workers with those of clinic-based nurses in a rural Ugandan district. Researchers successfully followed 777 DMPA clients (82% follow-up): 449 community worker clients and 328 clinic-based clients. Ninety-five percent of community-worker clients were “satisfied” or “highly satisfied” with services, and 85% reported receiving information on side-effects. There were no serious injection site problems in either group.
In this issue, we consider the potential for reducing barriers to sustained use of contraception by training community-based health workers to provide injectable methods.
This kit provides information and tools with which decision-makers can advocate for and initiate community-based distribution (CBD) of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA or Depo-Provera). Drawing on research and programs from Africa, Asia, and Latin America, the kit presents seven briefs with evidence supporting the safety and efficacy of CBD provision of DMPA. It discusses best practices for successful CBD of DMPA provision, such as training, counseling, and ensuring supply.
In collaboration with Save the Children USA and the Uganda Ministry of Health, Family Health International (FHI) conducted a cohort study demonstrating the safety, feasibility, and acceptability of community-based distribution (CBD) of depot medroxyprogesterone acetate (DMPA or Depo-Provera) in a rural Ugandan district. Though paramedical provision of injectables has become routine in regions such as Asia and South America, the findings from this study are relevant because concerns about safety have rendered the practice highly controversial in sub-Saharan Africa.
This brief provides an overview of the importance of mobile outreach service delivery, describes what this service delivery model entails, and gives guidance on how to plan and implement mobile family planning services.
Clinical outreach – the delivery of clinical health services by a mobile team of trained providers through periodic visits to a particular site or from a mobile unit – is an invaluable service delivery option for governments and service providers that are eager to reach underserved communities. This paper identifies a number of key lessons and emerging practices drawn from outreach programs of Marie Stopes International that can be taken to make clinical outreach programs more robust and effective.
This handbook provides general guidance on how to design and implement mobile outreach family planning services, and should be adapted to each country’s context. Several examples of country experiences with mobile services are provided in the handbook.
This presentation is focused on mobile outreach services, as there is increased interest in using this strategy for getting long-acting and permanent methods (LAPM) services to hard-to-reach or under-served areas. The presentation provides lessons being learned in-country as programs are being rolled out.
This issue of The Manager helps reproductive health managers develop solutions to bring services to hard to reach, underserved populations and discusses the kinds of groups that are hard to reach, how to select a group to serve, and methods for determining their reproductive health needs.
This report describes Pathfinder's efforts at the grassroots level to expand access and knowledge, stimulate acceptance, and create awareness and ownership of reproductive health and family planning programs. It covers some of the lessons learned of what makes community-based programs thrive and provides examples of how these programmatic concepts are integrated into their work.
Lessons learned include:
Depot-holders are women from the community who promote good health practice and use of clinics. They keep a stock of contraceptives and oral rehydration salts to supply other women and are paid some incentives. In 2003, the NGO Service Delivery Program (NSDP) introduced depot-holders in three types of urban area in Bangladesh as a pilot.
The report, in its first part, destroys three common myths regarding the private health care sector in Africa and discusses how to engage the private sector effectively. It provides examples of successful public-private partnerships and highlights some of the trends in these types of partnerships.
This issue of The Manager helps reproductive health managers develop solutions to bring services to hard to reach, underserved populations and discusses the kinds of groups that are hard to reach, how to select a group to serve, and methods for determining their reproductive health needs.
WHO Upholds Guidance: Women With or at Risk of HIV Can Safely Use Hormonal Methods
WHO released a statement on February 16, 2012, upholding guidance indicating that women with HIV or at high risk of HIV can safely use hormonal contraceptives, including injectables, to prevent pregnancy. However, WHO is instructing health care providers to strongly advise such women who decide to use progestin-only injectables to also always use male or female condoms for protection against HIV. Read more about WHO's statement.