Community-Based Family Planning
Why is community-based family planning (CBFP) an essential part of family planning programs?
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.
Definitions (via GHeL)
- 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.
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:
- 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.