Community-based Health and Family Planning
This publication examines existing community-based distribution (CBD) programs for family planning and other health care measures and discusses some principles of organization and management. CBD programs have 4 essential features: community residents who are not health professionals deliver supplies and services, services are delivered to communities or households rather than to clinics, CBD workers operate without day-to-day supervision, and many record keeping, diagnostic, and screening procedures are omitted because they are not practical for community workers. CBD overcomes geographic, cost, bureaucratic, and cultural barriers to health care. The more than 70 existing CBD programs differ in services offered, fees charged, means of delivery, presence of research components, and in whether they are single purpose, integrated, government-sponsored, or private. In designing or expanding CBD programs, the health problems of the community, availability of effective remedies, and ease and safety of services and supplies must be considered. 6 aspects of CBD programs which are likely to be most difficult are discussed: recruiting effective workers, training workers in new skills, providing continued training and supervision, coordinating backup with the existing medical system, keeping supplies flowing, and establishing an evaluation system. Experience in integrated family planning and CBD health programs is inconclusive, but a few lessons are clear: CBD projects should avoid a service overload, new activities should be phased in step-by-step, community participation is desirable, combining family planning with other services is not necessary to make family planning acceptable although it may help meet other primary health care needs, and research on design and implementation of CBD programs is needed. Experiences and problems with CBD programs for health measures in addition to family planning are described, including oral rehydration therapy for diarrhea, malaria treatment, intestinal parasite treatment, nutrition education and supplements, and immunization. A table listing characteristics of selected community-based integrated family planning and health projects is included.