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

APC Resources

APC Revue du Programme Pays Bénin
August 2019 | Report

Entre septembre 2012 et avril 2019, le projet Advancing Partners & Communities (APC) financé par l’USAID et mis en œuvre par JSI Research & Training Institute, Inc. et FHI 360, a soutenu des programmes de santé communautaire au Bénin, principalement dans les 10 zones sanitaires de l’USAID et au niveau national.

Population Health And Environment: Changing The Story Of Communities Within The Greater Amanzule Wetland Area in Ghana
July 2019 | Photo Gallery

Explore the story and lessons learned from the PHE project, Integrating Health and Family Planning into Greater Amanzule Wetland (GAW) Landscape Conservation and Small Scale Fisheries Management in the Western Region of Ghana.

Strengthening Multisectoral Approaches to Increase Access to High-Quality Family Planning Services in Uganda
July 2019 | Brief

Effective and sustainable health interventions are coordinated, multifaceted, and multisectoral, and leverage the resources and expertise of the public, faith-based, and private health sectors. This is especially the case with family planning activities, for which partnerships across health and non-health sectors have great potential to create demand for and improve delivery of family planning services.

Healthy Timing and Spacing of Pregnancies and Family Planning: Successful Approaches and Community Voices from Garba Tulla, Kenya
June 2019 | Project Highlight

Since 2014, through a grant by the USAID-funded APC project, World Vision Kenya has led the Healthy Timing and Spacing of Pregnancies project in Garba Tulla in northern Kenya, home to about 50,000 people.

Country Program in Review: Benin
May 2019 | Report

Between September 2012 and April 2019, APC supported community health programs in Benin, primarily in 10 USAID priority health zones and at the national level. The project focused on three main areas: 1) helping Benin reach its community health goals; 2) expanding and strengthening the country’s package of key health services and practices; and 3) institutionalizing and expanding community-based family planning.

Accomplissements du projet APC Bénin
May 2019 | Fact Sheet

Entre septembre 2012 et avril 2019, le projet APC financé par l’USAID et mis en oeuvre par JSI Research & Training Institute, Inc. et FHI 360, en partenariat avec le Ministère de la Santé du Bénin, a renforcé le système de santé communautaire dans le pays. APC a travaillé dans 10 zones sanitaires prioritaires de l’USAID, ainsi qu’au niveau national, pour améliorer la prestation des services et les interventions à haut impact (PIHI) dans les communautés et élargir la planification familiale à base communautaire. 

Photo Journal: Ameliorer la santé communautaire au Bénin
May 2019 | Photo Gallery

Entre 2012 et 2018, le projet Advancing Partners & Communities (APC) financé par l’USAID, en partenariat avec le Ministère de la Santé du Bénin, a renforcé le système de santé communautaire, en particulier la planification familiale. Cette collection de photos raconte l'histoire de ce travail.

Creating Global Resources for Developing Mobile Family Planning Applications for Community Health Workers
December 2018 | Brief

To align digital solutions that improve family planning service (FP) delivery among community health workers, APC is producing a generic set of resources that FP stakeholders can use as a starting point for developing FP mobile applications. APC is spearheading this effort in collaboration with international and local NGOs, technology firms, donors, and ministries of health.

Strengthening Community-based Family Planning Systems through Collaborative Improvement in Uganda: Lessons and Results
May 2018 | Brief

Since 2015, the Advancing Partners and Communities (APC) project has worked in partnership with the Ugandan Ministry of Health (MOH) to improve the quality of and access to community-based family planning (CBFP) services.

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.

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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.

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.

PATH is the leader in global health innovation. An international nonprofit organization, we save lives and improve health, especially among women and children. We accelerate innovation across five platforms—vaccines, drugs, diagnostics, devices, and system and service innovations—that harness our entrepreneurial insight, scientific and public health expertise, and passion for health equity. By mobilizing partners around the world, we take innovation to scale, working alongside countries primarily in Africa and Asia to tackle their greatest health needs.

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.

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June 20, 2019 | Announcement

Since May 2018, APC has been implementing activities in three sub-counties of Buyende District. Interventions have included community-based family planning; teaching cultural leaders about the role of improved parenting and school attendance in preventing teen pregnancy; convincing faith-based institutions to endorse and promote FP uptake; and making grants to local organizations.

June 19, 2019 | Event
Photo of the interactive session at the APC Uganda end of project event.
World Café table on Evidence informed transformative innovations for family planning from APC Uganda’s end of project learning event. Photo by Leigh Wynne, FHI 360.
May 24, 2019 | Event

APC’s Population Health and Environment (PHE) Integration Activity in Madagascar hosted a major dissemination event Friday, May 24, 2019, to share activity results, engage community members, and increase policymaker’s commitment to support PHE activities in Madagascar.

May 01, 2019 | Event

Watch the webcast recording from APC's May 1st event, Community Health Matters in the Journey to Self-Reliance, put on in collaboration with the Maternal Health Initiative at the Wilson Center.

March 01, 2019 | Article

Through a grant by the USAID-funded APC project, World Vision Kenya seeks to improve voluntary family planning and maternal, newborn, and child health in the remote area of Garba Tulla. Read the story of Hussein Ture, a nurse who worked at a public dispensary in the community of Barambate.

December 06, 2018 | Webinar

The sixth webinar in the Expanding Contraceptive Choice series will be on Tubal Ligation. The webinar is on Thursday, December 6, 2018, from 9:00–10:00 A.M. ET.

November 12, 2018 to November 15, 2018 | Event

APC plans to attend and present during several sessions at the 5th International Conference on Family Planning this November in Kigali, Rwanda. APC staff and representatives will join others in the family planning community to share best practices, recognize achievements, make renewed commitments to family planning, and chart a course forward. Join us as we contribute, learn, and celebrate this year’s theme, "Investing for a Lifetime of Returns."

August 31, 2018 | Blog

Read a blog by APC and APC grantee, ChildFund International, about a successful billboard campaign in Zambia used to help raise awareness around family planning and expanding the method mix. 

August 02, 2018 | Webinar

The fifth webinar in the Expanding Contraceptive Choice series will be on Vasectomy. The webinar was on Tuesday, August 2, 2018, from 9:00–10:00 A.M. ET.

April 24, 2018 | Webinar

The fourth webinar in the Expanding Contraceptive Choice series was on Intrauterine Devices (IUDs). The webinar was on Tuesday, April 24th, 2018, from 9:00–10:00 A.M. EST.

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Check back again for related photo galleries or videos.

HealthKeeper Tormeti introducing some products to clients.

A former worker of the Ghana Railways Authority, Angelina Tormeti is now a HealthKeeper who supports her family by selling family planning and other health products.

WellShare International conducted a district assessment on readiness for community-based access to injectables and results showed that only 3 out of the 55 Health Centers in Iganga offer youth-friendly services and that less than 10 percent of Health Center staff are trained in YFS.

Dangou Inoussa

APC Benin provides capacity building and technical assistance to a group of local NGOs that implement health interventions in maternal and child health, family planning, and other areas.

Frank Fianu educating his colleagues on condom use.

The HKN program trains distributors, known as “HealthKeepers,” who directly sell health-promoting products and counsel customers. HKN initiated outreach to work with commercial drivers—known as StationGuards—to promote a healthy lifestyle and provide their peers with reliable access to health protection products and services

Health Workers

WellShare International trained 257 village health team members in Uganda to provide adolescents with adolescent sexual and reproductive health counseling and family planning services.

Paul Mulawa is a 38-year-old Family Planning (FP) Champion and Village Health Team (VHT) member in the Iganga District, Ibalanku subcounty of Uganda. Elected by the community, Mulawa l’s VHT works within their community to promote FP, encourage individuals to immunize their children, and discuss hygiene in their homes.

Believe

Believe Semakor is a community health worker who has worked with HealthKeepers Network for almost two years.

Photo of Edward Basalirwa inspecting a patient's shoulder.

Edward Basalirwa is a 40-year-old Village Health Team (VHT) member and farmer from the Iganga District of Uganda. Edward was prompted to form a VHT Association in the Nsale Parish to improve the community’s well-being, and the VHT was elected in the community by the LC1 chairman, or village leader.

Peace Kpodo, HealthKeepers Network

Peace Kpodo, a health worker with HealthKeepers Network, provides services including education on family planning; dispelling myths and misconceptions about HIV and AIDS; and promoting and selling family planning commodities.

Photo shows Nana Akorlegah educating his male colleagues in his community on the use of condoms

Despite the largely invisible role played by men in terms of Family Planning and Reproductive Health Nana Kofi Akorlegah, a Health Keeper based in Ohiamadwen, a suburb of the Shama district in the Western Region, says he was determined to succeed and has no regrets joining the program.

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