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Community-based family planning programs can be combined with additional health
services, including disease prevention, prenatal and antenatal care and oral rehydration
therapy. In some cases, income-generating activities are included.
Also, community-based distribution (CBD) workers are beginning to provide family
planning services to youth and unmarried women, going beyond the traditional service
population of married couples. Some examples of these integrated approaches include the
following:
- In 1969, the three-year-old Thailand National Family Planning Program sought to increase
services to rural areas by allowing midwives to provide oral contraceptives. Midwives
learned to use a checklist to identify relevant health concerns and refer a woman to a
physician if necessary. After six months, pill use increased substantially in areas where
the approach was used, compared to a modest increase in pill use in other areas.
Continuation rates at six and 12 months were also higher among women served by midwives,
compared with women who received pills from physicians.1
-
- A study in rural Mali examined the impact of adding family planning services to an
existing primary health care system. Some health workers in two districts provided
contraceptives and information, while workers in two different districts provided only
family planning information. Client surveys showed contraceptive use and knowledge
increased more among people served by health workers who provided contraception. For
example, men's ever use of condoms increased from 9 percent to 35 percent among people
served by this group, and from 7 percent to 16 percent when only information was given.2
-
- In an effort to add family planning to an existing community-based delivery system, a
project in India has begun training 47,000 village medical private practitioners in the
Uttar Pradesh state to provide family planning services. Providers practice a combination
of traditional and modern medical practices; some have formal medical training while
others do not. Four to six days of training includes family planning counseling, provision
of condoms and pills, sexually transmitted disease prevention, and making referrals to
obtain intrauterine devices (IUDs) or sterilization. Since participants are private
practitioners, no supervisory system is used. The effort results in "a definite
improvement in counseling skills and knowledge of pills, condoms, IUDs and
sterilization," says Meenakshi Gautham, project manager in India for the U.S.-based
INTRAH program.
-
- In Honduras, community volunteers were trained to make referrals for family planning and
other health services based on a checklist of simple questions involving each client's
general and reproductive health needs. Volunteers contacted nearly 1,200 women in 11
villages and approximately 60 percent of the women were referred for services. Using
"simulated clients" to evaluate the approach, volunteers made appropriate
referral decisions 85 percent of the time, considered to be a successful result. The
incorrect decisions were equally divided between clients who should have been referred but
were not and clients who were referred when no service was needed.3
-
- In Tanzania, community-based agents were as much or more productive if they provided
other health services as well as family planning. A study compared the output of agents
who only provided family planning and maternal and child health referral services with
agents who provided these services in addition to other activities. Each agent providing
the additional services saw an average of 147 clients per year, resulting in 21 couple
years of protection (CYPs), while other agents on average saw 110 clients per year,
with 18 CYPs. Agents said that providing a broader range of services made them more
productive. Agents not providing such services as information and referral services about
sexually transmitted diseases expressed a need to receive training for a broader range of
services. The agents "pointed out that their community members ask them questions and
request services beyond family planning."4
-
- In a survey of Kenyan CBD clients, where many different models are used, about 90
percent of respondents favored agents who can provide counseling, including information
about sexually transmitted diseases. Most of those interviewed also supported CBD workers
discussing family planning with young adults (80 percent) and unmarried women (83
percent). Scientists concluded that CBD agents should be trained more thoroughly in other
reproductive health issues and encouraged to act as sources of information for other
community members, especially youth.5
-
- Intervention projects have shown that community family planning workers contribute to
better maternal health. In Bangladesh, door-to-door family planning workers were trained
to counsel pregnant women about how to recognize obstetric emergencies and the importance
of seeking treatment promptly if the symptoms appear. To assist illiterate women, the
workers used pictorial cards such as one showing labor pain lasting more than 12 hours as
a reason to seek treatment.6
-- William R. Finger
References
- Rosenfield AG, Limcharoen C. Auxiliary midwife prescription of oral
contraceptives: an experimental project in Thailand. In Foreit JR, Frejka T, eds. Family
Planning Operations Research: A Book of Readings (New York: Population Council,
1998)69-81.
- Katz KR, West CG, Doumbia F, et al. Increasing access to family planning
services in rural Mali through community-based distribution. Int Fam Plann Perspect 1998;24(3):104-10.
- Operation Research Summaries. Community Volunteers Successfully Refer
Women to Reproductive Health Services. New York: Population Council, 1998.
- Chege J, Rutenberg N, Janowitz B, et al. Factors Affecting the
Outputs and Costs of a Community-based Distribution of Family Planning Services in
Tanzania. (New York, NY: Population Council, 1998)22.
- Chege JN, Askew I. An Assessment of Community-based Family Planning
Programmes in Kenya. Nairobi: Population Council, 1997.
- Ashraf A, Ahmed S, Phillips JF. Developing doorstep services. In Khuda
B, Kane TT, Phillips JF, eds. Improving the Bangladesh Health and Family Planning
Programme: Lessons Learned through Operations Research. (Dhaka, Bangladesh:
International Centre for Diarrhoeal Disease Research, Bangladesh, 1997)20-21.
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