Community-Based Family Planning
Family planning is a common component of community-based health programs, often combined with other maternal and child health initiatives. Community-based family planning programs may be a formal part of the national health system or be limited to a specific area where an implementing partner is working. To ensure that CBFP programs respond to community needs, programs must engage community members in the design, implementation, and management of the program as much as possible. CBFP should be considered part of a broader community health strategy—known as a total market approach—to ensure that the community-based approaches offer a sustainable solution for meeting the family planning needs of the population. CBFP approaches that have been proven to extend services into the community include the following:
Continue reading to learn more about community-based family planning approaches.
Community health worker (CHW) programs: CHWs are trusted members of the community who are trained to support the general health of community members. CHWs are linked with community health facilities, district health offices, and in some countries national ministries of health and nongovernmental organizations (NGOs). Among the methods CHWs offer are condoms, oral contraceptives, injections, implants, and emergency contraception pills, in addition to information about standard days method and lactational amenorrhea method. This may take the form of visits to the client’s home, client visits to the CHW’s home, or visits at a community health post or another location in the community, in a private and confidential setting.
Drug shops (privately accredited drug dispensing outlets): Small commercial drug shops and pharmacies are often the first line of health care in poor countries, especially in rural areas that have very few private or public clinics. Drug shops, in contrast to pharmacies, are usually more numerous and do not typically employ a trained pharmacist. Also known as chemists or patent medical vendors, drug shop operators commonly offer medical advice, private consultations, and treatment. They are legally allowed to sell only non-prescription drugs and prepackaged medicines. Like pharmacies, many drug shops also sell over-the-counter family planning methods like condoms and oral contraceptives, providing an alternative source of contraceptive methods when there are supply shortages and stockouts in public sector facilities.
Mobile outreach services: Mobile outreach involves a team of health care providers who 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. The purpose of mobile services is to make as many contraceptive methods available to underserved and hard-to-reach groups as possible. When mobile outreach services are well-designed, they help programs broaden the contraceptive method mix available to clients, including increasing access to long acting and reversible contraceptives (LARCs) and permanent methods. LARCs and permanent methods are typically unavailable in most rural or hard-to-reach areas due to lack of skilled providers, commodities, and equipment.
The success of CBFP relies on collaboration with the government and existing health systems. CBFP utilizes task-sharing, which is cost-effective and supports the growth of CBFP programs. Task-sharing is delegating tasks—where appropriate—to less specialized workers in order to expand the reach of services provided. The goal of CBFP is to provide women and men with resources for making informed decisions regarding their reproductive health.
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The Family Planning 2020 goal of reaching 120 million additional women and girls in the world’s poorest countries with modern contraception by 2020 can only be achieved if contraceptive services are extended beyond the facility and into communities. Community-based family planning (CBFP) brings family planning information and contraceptive methods to women and men in the communities where they live rather than requiring them to travel to health facilities.
- Community health workers, mobile outreach, and drug shops are proven community-based approaches to family planning programming.
- CBFP programs can increase use of contraception, particularly where unmet need is high, access is low, and geographic, economic, or social barriers to use of services exist.
- CBFP programs can reduce inequities in access to services by bringing information, services, and supplies to women and men in the communities where they live and work.
- Long-acting reversible methods (LARCs): Contraceptive methods that prevent pregnancy for an extended period of time without requiring user action, but do not permanently affect ability to have children. These include IUDs and hormonal implants.
- Permanent methods: Male sterilization (vasectomy) and female sterilization (tubal ligation) are highly effective contraceptive methods that are considered permanent. They are suitable for couples who are certain they do not want any more children.
- Task-sharing: Sometimes known as task-shifting, this is the delegation of tasks, where appropriate, to less specialized workers. Task-sharing involves training mid- and low-level cadres of health workers—such as clinical officers, auxiliary nurses, and CHWs—to deliver some services typically offered by higher-level cadres—such as doctors—in order to further the reach of a limited health workforce.
The Global Health eLearning Center offers a course Community-Based Family Planning. The course, which has recently been updated and revised, orients the learner to the essential elements for designing and implementing successful, sustainable CBFP programs. It describes three popular approaches to CBFP—provision by community health workers (CHWs), mobile outreach services, and drug shops—and provides an opportunity for users to practice what they learned using a case study.
Population, Health, and Environment explores the intersections of these three facets of development. Learners will understand the fundamentals of the PHE approach including PHE relationships, the benefits of integration, program considerations, the PHE policy and advocacy landscape, and how the PHE approach can contribute to global development priorities, such as the Sustainable Development Goals and Family Planning 2020 in an efficient and effective way.
USAID’s Training Resource Package for Family Planning (TRP) offers curricula and tools for trainers to design, implement, and evaluate family planning and reproductive health (FP/RH) training. All TRP modules are available for free download and adaptation for local contexts. Modules include comprehensive lessons on a variety of family planning options as well as general sessions on the benefits of family planning, family planning counseling, and WHO guidance for family planning providers. The TRP also offers users general resources on instructional design and training of trainers to support users’ professional development goals.
Below is a selection of peer-reviewed articles on community-based family planning and related topics.
Agarwal S, Lasway C, L’Engle K, Homan R, Layer E, Ollis S, et al. Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania. Glob Health Sci Pract. 2016;4(2):315-325. Using mobile job aids can help CHWs deliver integrated counseling on family planning and HIV/STI screening by following a step-by-step service delivery algorithm. Lessons learned during the pilot led to the development of additional features during scale-up to exploit the other major advantages that mHealth offers, including better supervision of health workers and accountability for their performance, improved communication between supervisors and workers, and access to real-time data and reports to support quality improvement.
Weidert K, Gessessew A, Bell S, Godefay H, Prata N. Community Health Workers as Social Marketers of Injectable Contraceptives: A Case Study from Ethiopia. Glob Health Sci Pract. 2017;5(1):44-56. Volunteer community health workers (CHWs) administered injectable contraceptives to women in the community for a small fee while providing counseling and referrals for other methods. Over nearly 3 years, more than 600 CHWs provided an estimated 15,410 injections. The model has the potential to improve sustainability of community-based distribution programs by incorporating social marketing principles to partially recover commodity costs and compensate CHWs.
Gueye B, Wesson J, Koumtingue D, Stratton S, Viadro C, Talla H, et al. Mentoring, Task Sharing, and Community Outreach Through the TutoratPlus Approach: Increasing Use of Long‐Acting Reversible Contraceptives in Senegal. Glob Health Sci Pract. 2016;4 Suppl 2:S33-S43. Mentoring, task sharing, and community outreach at 100 rural facilities in Senegal led to an 86% increase over 6 months in the number of women choosing long-acting reversible contraceptives (from 1,552 to 2,879). Concurrent improvement of facilities and provider skills, coupled with the application of Senegal’s task-sharing policy, are increasing the range of contraceptive methods available to women throughout the country.
Charyeva Z, Oguntunde O, Orobaton N, Otolorin E, Inuwa F, Alalade O, Abegunde D, Danladi S. Task Shifting Provision of Contraceptive Implants to Community Health Extension Workers: Results of Operations Research in Northern Nigeria. Glob Health Sci Pract. 2015;3(3):382-394. With training and supportive supervision, male and female Community Health Extension Workers (CHEWs) in Nigeria safely and effectively provided contraceptive implants, and virtually all clients said they were satisfied. Most CHEWs achieved competency after five client insertions. However, the CHEWs provided only an average of four insertions per health facility per month. Realizing the true potential of providing implants calls for a context with dedicated providers and robust outreach.
Schaefer L. Task Sharing Implant Insertion by Community Health Workers: Not Just Can It Work, but How Might It Work Practically and With Impact in the Real World. Glob Health Sci Pract. 2015;3(3):327-329. Demonstrating that a health service, such as providing contraceptive implants, can be safely task shared to less highly trained workers is crucial but is only one step toward effective implementation at scale. Providers need dedicated time, enough clients, supplies, supervision, and other system support, allowing them to maintain their competency, confidence, and productivity.
The High Impact Practices in Family Planning (HIPs) team at USAID has developed briefs that synthesize the evidence and provide recommendations on how to implement selected HIPs.
Community Group Engagement: Changing Norms to Improve Sexual and Reproductive Health (2016; PDF, 690KB) describes the evidence on and experience with community group engagement (CGE) interventions that aim to foster healthy sexual and reproductive health (SRH) behaviors. The distinguishing characteristic of CGE interventions from other social and behavior change (SBC) interventions is that they work with and through community groups to influence individual behaviors and/or social norms rather than shifting behavior by targeting individuals alone. Specifically, community support can shift individual behaviors, including contraceptive behaviors, either by changing norms or individual knowledge and attitudes.
When appropriately designed and implemented, community health worker (CHW) programs can increase use of contraception, particularly where unmet need is high, access is low, and geographic or social barriers to use of services exist. CHWs are particularly important to reducing inequities in access to services by bringing information, services, and supplies to women and men in the communities where they live and work rather than requiring them to visit health facilities, which may be distant or otherwise inaccessible. Community Health Workers: Bringing family planning services to where people live and work (2015; PDF, 829KB) discusses the evidence for CHW programs, as well as the support and training CHWs need to be successful.
Mobile outreach services address inequities in access to family planning services and commodities in order to help women and men meet their reproductive health needs. Evidence demonstrates that mobile services can successfully increase contraceptive use, particularly in areas of low contraceptive prevalence, high unmet need for family planning, and limited access to contraceptives, and where geographic, economic, or social barriers limit service uptake. When well-designed, they help programs broaden the contraceptive method mix available to clients, including increasing access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs). Mobile outreach services: expanding access to a full range of modern contraceptives (2014; PDF, 429KB) describes the role of mobile outreach programs as a means of reducing inequities in access to family planning services (particularly LARCs and PMs), discusses the potential contribution of these programs, and outlines key issues for planning and implementation.
Small commercial drug shops and pharmacies are often the first line of health care in poor countries, especially in rural areas that have very few private or public clinics. Evidence shows that with appropriate training and support, staff can facilitate the use of modern contraception, especially in urban slums and rural areas where the unmet need is high, access is poor, and health-worker shortages and other barriers prevent men, women, and youth from accessing family planning services. Drug Shops and Pharmacies: Sources for family planning commodities and information (2013; PDF, 797KB) describes the importance of these outlets for distributing commodities and information and outlines key issues for planning and implementing programs to support pharmacy and drug-shop staff. In 2017, technical experts hosted a complementary webinar.