CBFP Approaches

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.  CBFP should be considered as part of a broader community health intervention—known as a total market approach (TMA)—to ensure that the CBFP approaches offer a sustainable solution for meeting the FP needs of the population. CBFP approaches that have been proven to extend services into the community include:

Community health workers (CHWs) or Community-Based Distributors (CBDs) are an effective means to bring FP information and services to women and men in the communities where they live. CHWs have an affinity for and understanding of the clients they serve because they are known in the community, come from the same or a similar cultural background, and as such, can respond to local societal and cultural norms and customs to ensure community acceptance and ownership. This insight allows CHWs to succeed in addressing social, cultural and traditional barriers to FP use. For decades, worldwide experience shows that CHWs can be trained to offer basic health services to their communities. These services include informed-choice counseling and safe provision of pills and condoms. More recently, technical experts concluded that CHWs can safely offer injectables and educate women and couples to use fertility awareness methods, such as the Lactational Amenorrhea Method (LAM) and Standard Days Method (SDM).

Drug shops (e.g., privately accredited drug dispensing outlets) are an effective means to expand the FP method mix, including injectable contraceptives, in underserved communities. Drug shops typically have storefronts, product displays, and a counter. Many have a small room in the back, separated by a curtain or door, for examinations and treatment. Drug shop operators sell a variety of medications including condoms and pills (in countries where pills are available over-the-counter). With training and supervision they could expand their current method mix to include other methods, such as injectable contraception. Clients in rural and hard-to-reach areas often prefer going to drug shops for FP methods where they can also access healthcare advice, treatments and supplies. The shops are particularly convenient for men and young people who may be less willing or able to go to clinics.  They also provide an alternative source of FP methods when there are supply shortages and stock outs in public sector facilities.  

Mobile outreach services are when a team of health care providers travels from a health facility to a community (or to a lower-level health facility) to offer FP services and methods to under-served and hard-to-reach groups in locations where FP services are limited or do not exist. Mobile services typically offer clinical, provider-dependent FP methods to communities whose access to a full range of methods, especially long-acting or permanent methods (LAPMs), is limited. This approach can greatly improve method mix in a community

Private sector actors cover a wide range of individuals and 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, comprised of for-profit and not-for-profit entities, lies outside the public health or government sector and increases points of access and meets some consumer.  Incorporating these actors are key factors in implementing a TMA for CBFP programs. TMA takes a holistic view of the situation and considers which combination of free, subsidized, and commercial product and public or private sector service delivery method will render a sustainable solution suited to institutional capacities and social contexts.

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