Community-Based Family Planning

Community-based family planning (CBFP) brings family planning information and methods to women and men where they live rather than requiring them to visit health facilities. One of the main objectives of CBFP programs is to increase access to and choice of contraceptive methods in underserved areas. CBFP programs work through a variety of channels, including community health workers, community depots, drug shops, mobile services, and the private sector. Advancing Partners & Communities supports the expansion of CBFP services to help accomplish the goal of making the full range of modern family planning methods available at the community level.  CBFP services involve a significant level of community ownership and should also be linked to the government’s health system so as to not duplicate, replace, or ignore the existing system.

Photo credit: Amy Cotter/USAID

Below are select resources related to key issues within community health systems strengthening.

Gender Norms of Health Care Providers

Gender norms are part of the community and affect everyone. Community health programs must recognize that everyone, including program designers and healthcare providers themselves, are socialized into certain ways of thinking and behaving as women and men, and about women and men. As a result, women and men often experience stigma and discrimination from healthcare providers. Healthcare providers should receive training in gender sensitivity to challenge their thinking about gender norms and be mindful of gender issues when interacting with clients.

Female Community Health Volunteer National Survey Report 2014
January 2016 | Report

The 2014 Female Community Health Volunteer (FCHV) survey provides a comprehensive assessment of the FCHV program in Nepal. The document reports the findings of a national-level quantitative survey of FCHVs and from complementary qualitative interviews with key national, district level, and community stakeholders. The results are intended to increase understanding of the current status of the FCHV program and reflect on stakeholder perceptions of program experience and performance.

Community Health Worker Motivation

In the face of global health worker shortages, the use of community health workers (CHWs) is an important health care delivery strategy for underserved populations. In Uganda, community-based programs often use volunteer CHWs to extend services, including family planning, in rural areas. This study examined factors related to CHW motivation and level of activity in three family planning programs in Uganda.

Community Health Policy Matters
May 2017 | Video

APC’s Community Health Policy Matters video tells the story of fictional characters Winnie and Mary, and how a fragmented health system affects each woman’s ability to access family planning services in her respective community. This animated video highlights how policy can improve the health system for women.

Nepal’s Community-based Health System Model: Structure, Strategies, and Learning
January 2016 | Brief

The Community-based Health System Model briefs identify and discuss critical health system inputs and processes that have contributed to the implementation and expansion of community-based service delivery in different countries. Countries were selected for their geographic diversity, type of service delivery model, and programmatic scale-up. This brief reviews Nepal’s community health model to inform future policy, program design, and implementation in other countries.

Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs
January 2014 | Study

This study examined factors related to community health workers (CHWs) motivation and level of activity in three family planning programs in Uganda. In the face of global health worker shortages, CHWs are an important health care delivery strategy for underserved populations. In Uganda, community-based programs often use volunteer CHWs to extend services, including family planning, in rural areas.

Community Health Workers Provision of Injectables

CHW provision of injectables is an important issue that should be widely expanded:

Sayana® Press: A Guide for Trainers of Providers
January 2015 | Training Guide

This trainer’s guide provides content for training on the progestin-only injectable contraceptive Sayana® Press. These materials were first used in 2012 to train facility- and community-based providers on use of Sayana Press (formerly depo-subQ in Uniject) in acceptability studies in Senegal and Uganda.

Long-Acting and Reversible Contraceptives

Long-acting reversible contraception (LARC)—intrauterine devices and contraceptive implants—are safe and appropriate contraceptive methods for most women and adolescents. Expanding access to LARC for young people will drastically reduce the rate of unintended pregnancies, unsafe abortions, and maternal and infant morbidity and mortality across the globe.

Situation Analysis of Community-Based Referrals for Family Planning
March 2016 | Brief

This analysis aims to review the evidence on current models of community-to-facility referrals for LARC/PM, to provide recommendations on promising models that should be tested for effectiveness, and to provide an agenda for future research.

Vouchers: Addressing inequities in access to contraceptive services
March 2015 | Brief

The just published HIP brief written by Ben Bellows, Population Council; Elaine Menotti, USAID; and Shawn Malarcher, USAID, describes how vouchers can address key challenges for family planning programs, discusses the potential contribution to improving the quality and use of contraceptive services, outlines key issues for planning and implementation, and identifies knowledge gaps.

CHSS

Strengthening Community-based Family Planning Systems through Collaborative Improvement in Busia District, Uganda
April 2017 | Brief

In this second issue of the APC Quality Improvement Brief, APC describes the progress to date in systematic efforts to improve the quality of CBFP in Busia District and plans to scale up these efforts in two other districts in Uganda.

Community-Based Family Planning Course
January 2017 | E-Learning

This course 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.

Applying a Quality Improvement Model to Strengthen Community-based Family Planning Services in Busia District, Uganda
April 2016 | Brief

In February 2015 APC, implemented by FHI 360 in Uganda, conducted a collaborative site assessment for CBFP programs with the MOH in the three pilot sites, Bulumbi, Buhehe and Buteba. The assessment identified areas for service delivery improvement, which were quantified by the QI monitoring that started in June 2015.

Below you will find links to resources created by APC and other organizations.

APC Resources

Self-Injection of DMPA-SC Leads to Improved Continuation Rates
September 2017 | Study

The Advancing Partners & Communities project conducted a randomized controlled trial comparing continuation rates of women using self-injected and provider-injected DMPA-SC contraceptives.

Community Health Policy Matters
May 2017 | Video

APC’s Community Health Policy Matters video tells the story of fictional characters Winnie and Mary, and how a fragmented health system affects each woman’s ability to access family planning services in her respective community. This animated video highlights how policy can improve the health system for women.

Strengthening Community-based Family Planning Systems through Collaborative Improvement in Busia District, Uganda
April 2017 | Brief

In this second issue of the APC Quality Improvement Brief, APC describes the progress to date in systematic efforts to improve the quality of CBFP in Busia District and plans to scale up these efforts in two other districts in Uganda.

Delivery of Injectable Contraception by Drug Shop Operators in Uganda: Research and Recommendations
October 2016 | Brief

At the London Family Planning Summit in 2012, the Government of Uganda committed to providing universal access to family planning and reducing unmet need for family planning from the current 40 percent to 10 percent by 2022. To meet this ambitious goal, all potential means of increasing accessibility to family planning must be explored.

In support of community-based emergency contraception
April 2016 | Journal Article

To read the full article on emergency contraceptive pills (ECPs), please register with Contraception Journal.

CHW Central - A Global Resource For Community Health Workers
April 2016 | Website

CHW Central, launched in 2011, is an online community of practice managed by Initiatives Inc. that provides a forum for online discussions and exchanges with public health professionals and program managers, policy makers and CHWs in the U.S. and across the globe.

Situation Analysis of Community-Based Referrals for Family Planning - July 2015
April 2016 | Report

This situation analysis report reviews the evidence on current models of community-to-facility referrals for long-acting and permanent methods of FP (LAPMs), provides recommendations on promising models that should be tested for effectiveness, and suggests an agenda for future research. A literature review and key informant interviews were conducted to document the available evidence.

Applying a Quality Improvement Model to Strengthen Community-based Family Planning Services in Busia District, Uganda
April 2016 | Brief

In February 2015 APC, implemented by FHI 360 in Uganda, conducted a collaborative site assessment for CBFP programs with the MOH in the three pilot sites, Bulumbi, Buhehe and Buteba. The assessment identified areas for service delivery improvement, which were quantified by the QI monitoring that started in June 2015.

Situation Analysis of Community-Based Referrals for Family Planning
March 2016 | Brief

This situation analysis aims to review the evidence on current models of community-to-facility referrals for LARC/PM, to provide recommendations on promising models that should be tested for effectiveness, and to provide an agenda for future research.

Nepal’s Community-based Health System Model: Structure, Strategies, and Learning
January 2016 | Brief

The Community-based Health System Model briefs identify and discuss critical health system inputs and processes that have contributed to the implementation and expansion of community-based service delivery in different countries. Countries were selected for their geographic diversity, type of service delivery model, and programmatic scale-up. This brief reviews Nepal’s community health model to inform future policy, program design, and implementation in other countries.

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The Adventist Development and Relief Agency (ADRA) is an international non-governmental organization (NGO) that provides individual and community development and disaster relief in over 120 countries worldwide. ADRA’s community development efforts promote health, provide food and water, and empower children through education. Their disaster relief projects coordinate with local governments to deliver medical care, food, water, and shelter to affected populations.

DKT International is a non-profit that promotes family planning (FP) and HIV/AIDS prevention through social marketing. DKT International’s Ghana initiative uses two social marketing strategies to address the unmet need for FP. The organization drives demand by brand building using mass media and non-traditional communication. DKT also increases commodity security through the distribution of high quality, affordable contraceptives.

Global Team for Local Initiatives (GTLI) works in southwest Ethiopia to facilitate local initiatives in enhancing long-term adaptability and resilience of indigenous communities in adapting to environmental changes. The organization implements projects in water, sanitation, and hygiene (WASH), income generation, and education programs for adults and orphans and other vulnerable children (OVC). GTLI’s primary focus and impact measurement is behavior change.

The HealthKeepers Network (HKN) was created to fill the health services and information gap in Ghana. HKN utilizes a franchise system that provides reliable service by mobilizing entrepreneurial women to distribute health commodities and information to rural villages. The system employs a door-to-door approach, encouraging community involvement in the distribution process. Community members and local caregivers are also encouraged to provide counseling on correct product usage.

HealthRight International addresses health and social challenges aggravated by human rights violations for key populations worldwide. The organization focuses on issues related to HIV/AIDS, women’s health, malaria, tuberculosis, orphans and other vulnerable youth (OVC), and other individuals affected by human rights violations. HealthRight International’s Partnership for Maternal and Neonatal Health Plus (PMNH+) program was launched in 2012 under USAID’s Child Survival and Health Grant Program (CSHGP) to improve child survival and maternal health across Kenya.

The International Center for Research on Women (ICRW) is a global research institute with headquarters in Washington, D.C., and regional offices in Nairobi, Kenya, and New Delhi, India. Our research evidence identifies women’s contributions as well as the obstacles that prevent them from being economically strong and able to fully participate in society. ICRW translates these insights into a path of action that honors women’s human rights, ensures gender equality and creates the conditions in which all women can thrive.

Pathfinder International is driven by the conviction that all people, regardless of where they live, have the right to decide whether and when to have children, to exist free from fear and stigma, and to lead the lives they choose. Since 1957, they have partnered with local governments, communities, and health systems in developing countries to remove barriers to critical sexual and reproductive health services. Together, they expand access to contraception, promote healthy pregnancies, save women’s lives, and stop the spread of new HIV infections, wherever the need is most urgent.

Precision Development Xperts is a local Ghanaian NGO with an overall mission of empowering communities and individuals to adopt improved health behaviors for total human development. Over the years, Precision Development Xperts has implemented a number of health projects including bednet distribution, point of use water purification, and community-based family planning.

The Salvation Army World Service Office (SAWSO) supports and strengthens The Salvation Army’s efforts to work hand in hand with communities to improve the health, economic, and spiritual conditions of vulnerable populations worldwide. SAWSO provides HIV/AIDS and community health services, disaster relief, and economic strengthening activities. They also offer seminars to raise awareness and train community members to eliminate human trafficking.

WellShare International, founded in 1979, has a mission to advance sustainable community health around the world. WellShare applies a holistic approach that builds effective partnerships, engages community health workers to bridge the gap between communities and the formal health sector, rigorously evaluates outcomes, and promotes long-term sustainability. WellShare reaches its goal of healthy people through a focus on health education, transfer of simple technologies, and connecting people to timely and appropriate health resources.

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December 07, 2017 | Event

Please join Advancing Partners & Communities for the second webinar in the Expanding Contraceptive Choice series: Fertility Awareness Methods, on Thursday, December 7th, 2017, from 8:30–9:30 A.M. EST.

November 04, 2017 to November 08, 2017
| Event

Join Advancing Partners & Communities at this year's American Public Health Association Annual Meeting from November 4 - November 8, 2017.

October 26, 2017 | Blog

On World Contraception Day, the Government of Benin formally acknowledged Sayana Press as a fully registered contraceptive choice in Benin. The launch of Sayana Press is a milestone that will give women and young people a chance to meet their reproductive needs.

October 12, 2017 | Event

The Advancing Partners & Communities project, in collaboration with Family Planning 2020, the Implementing Best Practices initiative and USAID’s Office of Population and Reproductive Health, will host the first webinar in a webinar series designed to share information about various family planning methods on Thursday, October 12th, 2017, from 9:00 A.M.-10:00 A.M. EST.

September 28, 2017 | Event

Join APC grantee Christian Connections for International Health (CCIH) and the Christian Journal for Global Health for a discussion on the Global Church and Family Planning on September 28, 2017, from 9:00-10:00 A.M. US ET featuring programs in Uganda, Nepal, and India.

September 25, 2017 | Blog

In May 2016, relais communautaires began introducing Sayana Press. In the three months since introduction, more than 450 women have received the contraceptive injection.

In this new video from Advancing Partners & Communities' grantee, World Vision, the Healthy Timing and Spacing of Pregnancies/Family Planning project seeks to increase access and use of voluntary family planning services in North Eastern Kenya.

April 26, 2017 | Announcement

The Family Planning Voices (#FPVoices) Tumblr documents and shares real stories from real people around the world who are passionate about family planning. Dr. Tonny Tumwesigye shares his story.

January 31, 2017 | Blog

The continued interest in the Global Health eLearning Center’s CBFP course is evidence of a growing global demand for programming resources in this high impact practice.

September 23, 2016 | Announcement

In Zambia, APC supported authorization for the national scale-up of Community Health Workers’ (CHW) provision of injectables after years of advocacy, multi-sectoral leadership and completion of a successful pilot study. The APC grantee ChildFund’s successful project in Zambia was one of the key factors influencing the government’s decision to allow trained CHWs to provide injectable contraception. This authorization will give women, especially those in rural, hard-to-reach areas, access to a safe and reliable family planning method and help Zambia reach its goal of increasing the modern contraceptive rate to 58% by 2020.

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Check back again for related photo galleries or videos.

Photo of Alemnesh Assefa at work at a desk

Alemnesh Assefa is a 27-year-old Health Extension Worker (HEW). She is a government employee health worker who serves in a village, where the lowest health structure is called a health post where two HEWs serve a population of 5000.

Photo of two women and a man meeting indoors

To respond to the unmet need for family planning (FP) in Uganda, the Salvation Army Integrating Family Planning (SAIFaP) Project organized mobile outreach activities in hard to reach areas.

Photo of Beatrice

As a peer educator with the HealthKeepers Network (HKN), Beatrice Ghartey receives training in many areas including adolescent reproductive health, sexually transmitted infections, prevention of teenage pregnancy, sexual abstinence and youth friendly services.

Photo of Fanny

Madam Fanny Stafford is the patron of the Young Peer Educators Club established by the HealthKeepers Network (HKN), a non-governmental organization based in Accra.

Stella Nyarko introducing health products to her clients

Stella Nyarko became a HealthKeeper through a women’s association. She now provides communities with family planning information and health protection products.

Mr. Tetteh (right) sharing ideas with a passenger

Bernard Tetteh is a 45 year old station guard and transport service operator in Anloga, in the Volta Region. As a station guard, he takes the opportunity to educate people on reproductive health issues.

Photo of a DKT Community Representative in the Eastern Region gives family planning education to a community savings group in Oborpa, in the Manya Krobo Municipal district. Photo Credit: F. Nuertey

Although modern contraceptive methods are widely available in family planning facilities across all ten regions of Ghana, convincing women to adopt a method continues to be a challenge.

Mrs. Diana Bona (standing) during one of her outreaches

Diana Bona, a public health nurse and the regional focal person for adolescent health in the Greater Accra region, is committed to increasing access to adolescent health education in schools within her region.

Through partnership with local government and lower health centers, WellShare International is offering community-based HIV counseling and testing services through outreaches and is integrating family planning alongside other services.

Mrs. Patience Gyasi explains how to use the secure pill to a client.

Mrs. Patience Gyasi is a licensed chemical seller at the LA Dadekotopon District, in the Greater Accra Region. For the past 25 years, she has devoted her life to providing health care, including family planning services to her community.

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