Repositioning in Action E-Bulletin
November 2006
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Expanding Key Best Practices in Community-Based Programs
The last issue of the E-Bulletin discussed some key clinic-based practices to improve programming. This issue addresses key practices that can be added to existing programs, which rely on community health workers to expand access to reproductive health services outside of clinic walls. |
USAID has identified key best practices that it recommends for family planning and reproductive health programs. These
practices and interventions, which have been carefully researched and evaluated across different settings, boost results and
improve program effectiveness. USAID is supporting efforts to use these practices globally in more of its programs.
The following criteria determine USAID’s selection of key practices in Reproductive Health.
Cost: They are inexpensive to implement and do not require significant additions to existing programs in terms of capital
or human resources and long-term technical assistance.
Potential Impact: They have high potential for impact on increased use of contraception or other RH interventions.
Evidence of Effectiveness: There is solid evidence that they work, and there is experience replicating them or bringing
them to scale.
Engaging community resources is critical for family planning, especially in countries that have a high percentage of people living in rural areas. Activities generated at the community level can have a powerful effect on changing the societal norms and beliefs about reproductive health, creating acceptance and demand for family planning. Community-based distributors
(CBD) can help to fulfill new and existing demand for family planning through increased access to particular methods in
places that may not have access to a clinic. Communities that have CBD programs in place can optimize their programs by
empowering more CBD workers through tools and an expanded method mix, which can be safely offered to women and
men in the community.
- Improving access to a broader range of contraceptive methods through CBD and social marketing programs:
- Community-based and social marketing programs can safely offer condoms, oral contraceptives, injectable contraceptives,
emergency contraception, and standard days method.
- Studies have demonstrated higher continuation rates for women who receive injectables through community-based programs.
- Recent product changes, such as the auto-disable syringe, which are available through USAID and UNFPA, reduce the risk of spreading infection through unsterilized injection equipment.
- Studies have shown that CBD workers can be trained to safely and effectively supply an expanded
range of contraceptives. Community-based health workers can safely initiate and continue contraceptive use by following simple-to-use provider checklists to screen clients for safe contraceptive use:
- Checklists improve the quality of care provided by community health workers to accurately screen clients for safe contraceptive use.
- Greater ability to safely provide contraceptives at the community level removes unnecessary medical barriers to
contraceptive use, such as requiring a visit to a medical doctor or clinic.
- More information is available at: http://www.fhi.org/en/RH/Pubs/servdelivery/checklists/index.htm
- Recruiting men as CBDs for reproductive health increases their knowledge and awareness about family
planning and improves access to contraceptive methods among men and women:
- Men distribute more condoms than female CBD workers and are as equally productive as female CBD agents in
terms of delivering couple-years-of-protection (CYPs).
- Communities accept men as family planning workers, although programs may need to accommodate schedules and
programs to utilize men in this role.
- Giving a role to men as CBD workers can be critical to changing societal norms toward family planning at the community level.
- More information is available at: http://www.popcouncil.org/pdfs/frontiers/pbriefs/male_CBDs_brf.pdf [PDF, 211KB]
Some USAID programs are utilizing these practices to enhance and strengthen their community-based programming. In
Ethiopia, Pathfinder deploys male CBD workers to supply condoms and pills and provide norm-changing communications
to reduce the incidence of female genital mutilation to rural communities throughout the country.
Save the Children’s CBD workers in Uganda have demonstrated that they can effectively provide injectable contraceptives at the community level with the use of the provider checklists. The successful pilot is now being expanded, and the
Ministry of Health is drafting language to change the norms in Uganda to allow CBD workers to provide this popular
method throughout the country. Visit the Family Health International website [PDF, 274KB] to read the CBD Depo Final Report.
SantéNet in Madagascar is currently carrying out a demonstration project of CBD of injectables that will guide the national
expansion of strengthening the abilities of CBD workers throughout the country.
In Senegal, Tostan and the Christian Children’s Fund are mobilizing communities and training CBD workers to offer the
standard days method at the community level with information and method availability.
USAID can help programs by providing information and assistance to introduce key best practices into programs, so community
health programs are optimized.
We would like to hear your stories about adopting key practices. Please contact Elizabeth Warnick (ewarnick@usaid.gov)
for more information.
We Want to Tell Your Repositioning Story
Please contact Kim Ocheltree at kocheltree@usaid.gov with your successes in family planning programming.
For more information on Repositioning Family Planning, please contact Joan Robertson at jrobertson@usaid.gov or Alexandra Todd at atodd@usaid.gov.
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