Selecting Appropriate Community-Based Family Planning Strategies

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. There are four strategies for implementing CBFP activities:

Community-Based Distribution (CBD) Agents

Community Depots

Mobile Services

Engaging the Private Sector 

 
No single CBFP strategy is perfect. As a program manager, it is your task to select which strategy (or combination of strategies) is most appropriate for your community needs.
 

CBD Agents

CBD agents are community members who are selected, trained, and supervised to educate, counsel, and distribute contraceptive methods to women and men in their village or neighborhood.
 
Using the CBD agent strategy may be particularly good when:
  • Traditional, social, or religious customs discourage family planning, discourage discussion of sex and reproduction, or define childbearing as a "woman’s issue." CBD agents can help people understand that family planning is a personal and a community development issue. They can encourage debate and foster acceptance. As "community insiders," CBD agents can reach those who influence opinions and behavior, such as religious leaders, husbands, or mothers-in-law.
  • Social exclusion prevents some segments of a community from benefiting from other CBFP strategies. CBD agents can bring information and methods directly into households. This is important where some groups (for example, secluded women, the extremely poor, or the lowest caste) cannot benefit from other strategies for extending family planning services, such as community depots or mobile services.
  • Other community-based health services are needed. CBD agents, with their links to the health system, can be an entry point for other health services and directly provide these services. Examples include home-based care for people living with AIDS, directly observed therapy of tuberculosis, and community-integrated management of childhood illnesses. 

Community Depots

In a community depot system, an individual called a depot holder stores contraceptives within the community and distributes them to clients. A depot holder may or may not be a CBD agent.
 
The depot holder who is not a CBD agent can:
  • Sell or distribute condoms and spermicides.
  • Sell or distribute resupplies of oral contraceptives to existing users who originally obtained the method from a CBD agent or health worker. Typically, a depot holder does not have the training to provide oral contraceptives to new clients. The depot holder should refer new clients to the nearest CBD agent or health facility for proper screening. 
  • Where the policy permits, a depot holder can sell injectable contraceptives but not carry out the injection itself.
  • Judge when new or existing users need more assistance and refer them to the nearest CBD agent or health facility.
 
Using the community depot strategy may be particularly good when:
  • Demand for FP is already high, or demand is being heightened by other activities/strategies.
  • The depot’s primary purpose is continuity of methods and information for existing clients. The depot allows clients to resupply in the community rather than travel to the clinic.
 
Using the strategy alone may not be a good idea when:
  • Demand for FP is low, and no activities are in place to increase demand. A community depot, alone, does not increase demand for FP.
  • Social barriers prevent many people from adopting FP. A depot helps resolve the problem of users’ physical access to FP supplies but does not solve social access issues.

Mobile Services

With mobile services, a team of health care providers travels from a health facility to a community (or from a higher to a lower-level health facility) to offer family planning services and methods in areas where services are limited or do not exist. This strategy takes more planning but greatly improves method choice at the community level.
 
Mobile services can be effective when you want to:
  • Expand people’s access to a wider choice of methods, especially provider-dependent methods and long-acting and permanent methods (LA/PMs).
  • Bring family planning services to remote and underserved populations.
  • Provide adequate client caseloads for on-the-job training and refreshers to health workers.
For example, in areas with limited family planning services, people may have access to some family planning information and methods—typically condoms, pills, and perhaps injectables and fertility awareness methods. In this scenario, mobile services may be an appropriate, cost-effective way to bring LA/PMs to the community.
 
Mobile services may also be appropriate in areas with no family planning services to reach remote and underserved populations. In this scenario, the mobile team is the sole provider of family planning. The team must build demand for family planning through education and counseling and meet demand through regular visits. Typically, family planning is just one of a range of health services provided in this scenario. The mobile team may also provide pre- and post-natal care, immunizations, and other primary health care services.

Engaging the Private Sector

The private sector covers a wide range of entities including private practitioners, clinics, hospitals, laboratories, diagnostic facilities, NGOs, faith-based organizations, shopkeepers, traditional healers, pharmacies, pharmaceutical wholesalers, distributors, and manufacturers. This large and diverse group, comprising of for-profit and not-for-profit entities, lies outside the public health or government sector.
 
Engaging the private sector is important for several reasons: 
  • Access. There are a limited number of public sector clinics, hospitals, and dispensaries. The private sector can add thousands of new access points for FP products and services through pharmacies/drug stores and private providers.
  • Health-seeking behavior. Consumers in developing countries spend a substantial portion of their health care dollars in the private sector. Pharmacies and drug stores are often the first stop when seeking health care. Ensuring access to essential, high quality contraceptives in the private sector meets consumer preferences for access.
  • Cost-effectiveness. Consumers who perceive that the private sector providers and pharmacies offer more choice, quality, and convenience and are willing to pay for these services. This allows the public sector services to be used by those with very limited ability to pay.
Collaboration between non-profits or NGOs is a common way that organizations increase the value of their programs in a budget-friendly way. No NGO has all the expertise it needs, and it makes sense to seek the professional services of other non-profits.
 
Look around you for non-profits that may specialize in the following elements:
  • Training
  • Educating individuals and groups
  • Building local capacity 
  • Developing media
Your project may also find local expertise, materials, or equipment in the for-profit private sector in many areas including:
  • Privately owned radio, television or other media
  • Advertising
  • Development of job aids or IEC material
  • Market research
  • Health technology campaigns
  • Specialize in adult education, training, and refresher training
  • Transportation