Lessons from community-based distribution of family planning in Africa

This working paper reviews findings and experiences from efforts to implement community-based family planning services in Africa. The term community-based distribution (CBD) refers to programs of nonclinical family planning service that promote approaches involving safe and simple contraceptive technologies. In Africa these programs focus on the provision of oral contraceptives foam tablets and condoms. As CBD programs have been developed throughout Africa various assumptions have guided their operational design and presumed consequences. First the lack of convenient access to contraceptives represents the primary barrier to the practice of family planning. Second the efficacy of CBD in Africa is derived largely from the legacies of CBD in other programs. The CBD has expanded in sub-Saharan Africa and become the single most important family planning innovation. The typology illustrating the assumptions of CBD is characterized by the intersection of contraceptive demand and supply. Type I involves depots and market approaches type II involves doorstop services provided by paid workers and volunteers and type III involves community mobilization schemes and complex CBD. Discussions of the demographic role of family planning have focused on the relative role of the supply of services and the demand for family planning. The determinants of CBD success or failure include case studies of large-scale activities operation research pilot studies and field projects and specific studies of management issues in CBD. The CBD literature is diffuse and atheoretical which complicates the task of deriving cross-cultural themes or generic lessons. The CBD experience in Africa has provided information about the effectiveness of an approach and a combination of approaches.

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