Community-based family planning (CBFP) programs bring family planning (FP) information and methods to women and men in the communities where they live, rather than requiring visits to health facilities.  The increased access provided by CBFP is particularly important for people living in remote areas, where transportation is difficult to find or expensive, where little is known about FP, in areas where cultural traditions support early marriage, large families, and where women’s mobility outside the home is restricted.  CBFP is directly related to achieving Millennium Development Goals #4 reduce child mortality and #5 improve maternal health. The Global Health Initiative (2010) includes CBFP under the second principle (to increase impact through strategic coordination and integration) and considers it a key strategy for meeting the large unmet demand for FP services in underserved areas.

Community-based distribution (CBD) programs have been in existence since the 1960s and Pathfinder International, one of the early organizations to establish CBFP and reproductive health (RH) programs, found that working with communities at the grassroots level is an effective way to both improve access and challenge socio-cultural barriers to RH/FP services (Pathfinder Int’l, 2006). In a review of more than 30 years of CBD programs, Prata et al. (2005) found that direct contact with CBD agents resulted in 3 to 10 times the amount of modern contraceptive use, although the costs of CBFP programs can be higher than for other delivery methods, such as public clinics or contraceptive social marketing.  The authors view CBFP as necessary in settings or countries where clinic- or hospital-based distribution are not adequate to meet FP need at the local level and, ideally, when combined with other FP delivery systems (Prata et al., 2005).  As part of the Implementing Best Practices (IBP) initiative, WHO and partner organizations have compared models for community-based RH/FP services with the goal of identifying effective practices worth scaling up.  Participants in the IBP process expressed the need for simple up-to-date tools for community-based health workers leading to the current work on an updated version of the WHO (2005) Decision-Making Tool for Family Planning Clients and Providers for use in the community (WHO, 2010).

The USAID sponsored Knowledge for Health (K4Health) website provides a toolkit for CBFP programs with resources ranging from background, policy and advocacy, to program design, training and monitoring and evaluation (M&E).  The Toolkit lists four strategies considered basic to CBFP: (1) use of CBD agents; (2) a community depot system; (3) mobile services; and (4) engaging the private sector.  CBD agents are community members who have been selected, trained, and supervised to educate, counsel, and distribute contraceptive methods to women and men in their village or neighborhood.  In a community depot system, a person (or depot holder who may or may not be a CBD agent) stores contraceptives within the community and distributes them to clients. With mobile services, teams of health care providers travel from health facilities to the communities (or from a higher to a lower-level health facilities) to offer FP services and methods in areas where services are limited or do not exist. While this approach takes more planning, it greatly improves method choice at the community level. Private sector entities can be important partners in developing and making CBFP programs sustainable.  Management Sciences for Health (MSH) provides a website dedicated to management resources with guidelines and links for community-based services. MSH (2010) emphasizes that gender roles and norms are especially important factors to consider in designing, managing, and delivering CBFP and RH services.

CBFP successes have led to continued and expanded programs in underserved areas, with the accompanying need for M&E of program components and resulting levels and trends in service utilization.  The five core indicators selected for this database cover training, access to and quality of services, and client use. While specific to CBFP, these indicators also correspond with more general indicators in the database technical area on Family Planning. The USAID Flexible Fund resource presents a list of recommended core indicators for implementing and evaluating RH/FP programs with an annotated Appendix (6) containing links for CBFP (USAID, 2008).  Additional indicators relevant to CBFP, such as local rapid assessments and questionnaires for CBD agents and supervisors can be found in the MSH website.

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References:

Management Systems for Health (MSH), 2010, Managing Community Health Systems, The Managers Electronic Resource Center Website, Cambridge, MA: MSH.

Pathfnder International, 2006, Improving reproductive health through community-based services, Watertown, MA: Pathfinder Int’l

Prata N, Vahidnia F, Potts M, Dries-Daffner i., 2005, Revisiting community-based distribution programs: are they still needed? Contraception. 72; 402-7.  

USAID, 2008, USAID Flexible Fund Guidance for Grantees, Washington, DC: USAID.

USAID/K4Heath, 2010, Community-based Family Planning Toolkit, Knowledge for Heath, USAID Office of Global Health Website, www.k4health.org. http://www.k4health.org/toolkits/communitybasedfp

WHO, 2010, Implementing Best Practices in Reproductive Health: Our first 10years, Geneva: WHO. http://www.ibpinitiative.org/images/OurFirstTenYears2010.pdf

WHO / JHPIEGO, 2005, Decision-making tool for Family planning clients and Providers, Geneva: WHO. http://whqlibdoc.who.int/publications/2005/9241593229_eng.pdf