Country Experiences

Community-based family planning (CBFP) is an effort to improve knowledge, availability, access and quality of family planning services. In some countries or regions CBFP is routine, while in other areas CBFP is a new alternative for family planning services to address unmet need and hard-to-reach communities. This Country Experiences section of the CBFP Toolkit provides examples of CBFP programming activities in various countries, including program models, strategies and implementation activities. These country experiences are intended to inform health policy makers, program managers, and service providers of the strategies, challenges, successes and lessons learned from CBFP activities.

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Country Assessments (7 resources)

This section of the Community-Based Family Planning Toolkit contains a number of resources that provide assessments of community-based family planning programs in various countries, including Ghana, Madagascar, Senegal, and Uganda.

    Experiences with Mobile Services (6 resources)

    In this section of the Community-Based Family Planning Toolkit, resources are provided from the International Planned Parenthood Federation, Marie Stopes International, and UNFPA describing their experiences with providing mobile outreach services in family planning and reproductive health in various countries, including Bolivia, Georgia, and the Philippines.

      Private-Sector Experiences (3 resources)

      In this section of the Community-Based Family Planning Toolkit, experiences from India, Mexico, and Madagascar are provided, which offer lessons learned from their programs. The programs ranged from equipping youth-friendly pharmacies in Mexico with accurate reproductive health information and contraceptive methods; building capacity of private providers in India to offer community-based distribution of contraceptive methods; and moving from offering free family planning methods to socially marketed products in Madagascar in order to work toward sustainable contraceptive management.

        Scaling Up and Sustainability (11 resources)

        Successful projects need to be scaled up to reach more people and more areas with more services, thus increasing impact. Projects also need to work toward sustainability so that improvements in health outcomes can persist even after external funding stops. This section of the Community-Based Family Planning Toolkit includes several country examples from around the world of projects that have scaled up either by reaching more people and areas or by offering more services. It also includes examples of country projects that have fostered sustainability in their communities.

          Community Involvement/Mobilization (20 resources)

          When community members help design and guide a health or development program, the community gains problem-solving skills and ownership of the program. These two important elements contribute toward sustainable results. A community's involvement in a CBFP program may be minimal, or it may be the driving force behind all activities. As you design your program, you should think about the range of community involvement and decide what level of involvement will help you meet your goals. Case studies of community-based programs that have incorporated participatory processes are included in this section of the Community-Based Family Planning Toolkit to give users an overview of different approaches that can be used.

            Behavior Change Communication Experiences (11 resources)

            Behavior change communication (BCC) programs communicate important public health knowledge to communities through tailored messages that engage and motivate people to adopt healthy behaviors. BCC programs may be disseminated through a variety of means of communication including story telling, theater, radio, TV, brochures, billboards, and even one-on-one communication. The reports in this section of the Community-Based Family Planning Toolkit provide a range of country experiences using different BCC approaches and media.

              Social Marketing (7 resources)

              Social marketing programs use commercial marketing concepts and techniques to motivate people to buy products and behave in ways that benefit themselves and society. In addition to using behavior change communication, or what the social marketing field refers to as “promotion,” social marketing approaches combine other elements of the marketing mix—the “product,” “price,” and “place”—into their programs (for example, contraceptives priced appropriately and available at good-quality clinics or pharmacies). Country experiences with social marketing approaches are provided in this section of the Community-Based Family Planning Toolkit.

                Experiences in Advocacy and Policy Change (9 resources)

                Advocating to and mobilizing policymakers, health officials, other stakeholders, and the community are necessary for garnering support and effectively implementing community-based family planning (CBFP) programs. This section of the Community-Based Family Planning Toolkit includes experiences with gaining stakeholder support for and/or scaling up of community-based services. Reports on programs in Ghana, Guatemala, and Uganda addressing policy issues that arise when implementing CBFP programs and services are included.

                  Experiences with Community-Based Access to Injectables (16 resources)

                  More and more community-based family planning (CBFP) programs are offering injectable contraceptives in the community. Research and programs in a wide range of countries have demonstrated that well-trained community-based workers can safely provide injectables. The resources in this section of the Community-Based Family Planning Toolkit provide safety and efficacy findings from studies in Afghanistan, Bangladesh, Guatemala, Malawi, and Uganda that have added injectable contraceptives to their CBFP programs. The case studies also address issues such as user satisfaction and quality of care.

                    Integrating Services (9 resources)

                    Offering multiple health care services through a community-based program can address a wider range of health needs conveniently for clients. Integrated services also can be more efficient and so can serve more people for the same program expenditures.This section of the Community-Based Family Planning Toolkit includes resources that describe experiences, achievements and lessons learned of community-based family planning programs that have added other health care services or family planning was added to other existing community-based health care servcies. The services most commonly integrated with family planning are HIV/STI care and prevention and maternal, newborn, and child health care.

                      Youth (3 resources)

                      In order for young people to reduce their risk of pregnancy or risk of contracting an STI when engaging in sex, they need access to contraceptive services and products. Barriers such as lack of information, stigma and judgmental attitudes often make it difficult for family planning providers to reach young people. Youth-friendly pharmacies, school-based facilities, and youth centers are examples of places that can provide contraceptive services and counseling to youth in the community setting. This section of the Community-Based Family Planning Toolkit includes resources that address family planning and reproductive health services for youth using community-based family planning strategies.

                        Training Experiences (3 resources)

                        Resources in this section relate to Pathfinder International's experience in Ethiopia with service delivery-based training of providers in long-acting family planning methods (IUDs and implants). One report describes how large numbers of clinicians were trained to provide IUDs and implants in the communities themselves to hundreds of clients at one time, with the help of community-based agents who built demand for the methods in their communities. The other report describes how health extension workers were trained to insert and remove Implanon implants using a similar service delivery-based training model.

                          CBFP in Post-Crises Environments (2 resources)

                          Conflicts and natural disasters challenge health care providers to meet people's basic needs, including reproductive health care. In general, family planning is as much in demand during a crisis as it was beforehand. Yet refugees may have far less access to contraception because services and supplies have been disrupted. Implementing community-based family planning strategies are an effective way to bring family planning and reproductive health services to refugees and internally displaced persons affected by crises. This section of the Community-Based Family Planning Toolkit includes country examples of family planning projects and programs in post-crises environments.