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

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

The executive summary for the 2014 Female Community Health Volunteer (FCHV) survey gives an overview of the FCHV program in Nepal. The document summarizes 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.

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.

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries
May 2015 | Journal Article

This article, contributed to by APC's Leah Elliot, analyzes data from recent Demographic and Health Surveys (DHS) conducted in 21 low- and middle-income countries (LMICs) to examine patterns of interpregnancy intervals, unmet need, pregnancy risk and family planning method use and method mix among women 0–23 months postpartum.

Peace Corps Maternal and Newborn Health Training Package
February 2015 | Toolkit

This training package introduces Peace Corps Volunteers to the fundamentals of maternal and newborn health and exposes them to key concepts and global trends. The training package highlights the latest evidence-based practices that can be implemented by Volunteers and their counterparts at the community level to improve maternal and newborn health outcomes. These modules were developed with support from APC.

Advancing Partners & Communities: Emergency Contraception in Uganda
January 2015 | Brief

This brief details a formative assessment of emergency contraceptive pills at the community level in Uganda. The goal of this assessment is to generate information for the development of information, education, and communication materials for better integrating EC into existing community-based family planning programs.

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.

Community Health Worker Provision of Injectable Contraceptives: An Effective CBA2I Strategy
October 2014 | Brief

These resources are intended to be used by advocates, program managers, policymakers, donors, ministry of health staff, and other key stakeholders to craft a strategy for building support for CBA2I among key decision makers in country. Because community-based access to injectable contraceptives (CBA2I) has the potential to significantly expand access to and use of modern contraceptive methods, several countries are employing CBA2I strategies to help achieve their FP2020 goals.

External Resources

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

This course from the Global Health eLearning Center orients the learner to the essential elements for designing and implementing successful, sustainable CBFP programs.

Community Health Workers: Bringing family planning services to where people live and work
January 2016 | Brief

This updated eight-page brief from High Impact Practices (HIP) describes the importance of community-based family planning programs as a means of reducing inequities in access to services and outlines key issues for planning and implementation. When appropriately designed and implemented, community health worker (CHW) programs can increase use of contraception, particularly where unmet need is high, access is low, and geographic or social barriers to use of services exist.

Family Planning for Frontline Health Workers
March 2015 | Toolkit

This module targets community health workers and other frontline health care workers who educate and counsel about family planning and provide short-acting family planning methods and refer for longer-term methods.

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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.

World Vision is a Christian relief and development organization that focuses its efforts on emergency relief, education, health care, gender issues, economic development, and child advocacy. World Vision partners with children and families to help them break the cycle of poverty using a community development approach.

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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.

January 25, 2016 to January 28, 2016
| Event

APC is playing an active role in the 2016 International Conference on Family Planning (ICFP) in Nusa Dua, Indonesia from January 25-28. Our members will come together with other experts in the family planning community to share best practices, acknowledge past successes and challenges, and plan for the future.

January 12, 2016 | Announcement

Nana Kofi Akorlegah, a Health Keeper from Shama, Ghana shares his experience as a Health Worker.

October 26, 2015 | Event

Are you attending the International Conference on Family Planning (ICFP) in November? Come and join SonkeGender Justice, one of the Advancing Partners & Communities Project’s grantees, for an interactive and exciting pre-workshop about men in family planning on November 11, 2015!

September 03, 2015 | Announcement

To address the gap in knowledge about the integration of emergency contraceptive pills (ECPs) within community-based family planning (CBFP) programs, APC convened a meeting in June 2015 on the integration of EC in CBFP programs. Learn more about the meeting and view the presentations.

July 01, 2015 | Announcement

WellShare International and APC undertook a formative assessment to evaluate current knowledge, use, supply, and barriers to the uptake of ECPs in four districts of Uganda where CBFP programs are operating. This assessment is the first of its kind in sub- Saharan Africa.

May 27, 2015 | Blog

This blog, written by APC Grantee World Vision, discusses the integration of Healthy Timing and Spacing of Pregnancies and Family Planning (HTSP/FP) within a community-based maternal, newborn, and child health (MNCH) program. 

May 20, 2015 | Announcement

APC's assessment of the Female Community Health Volunteers (FCHVs) in Nepal explores the job satisfaction of FCHVs, range of services provided, and challenges faced by FCHVs.

May 19, 2015 | Event

The Evidence to Action (E2A) Project invites you to a special event—“Fact or Fiction: uptake of long-acting reversible contraceptives among Ethiopian youth,” Friday, May 29, 1-2 pm EST.

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Check back again for related photo galleries or videos.

Photo of Nana Ohene Kwatia speaking with people outside their home.

Nana Ohene Kwatia, a HealthKeeper who lives at Frafraha-Old Town, a Suburb of the Adentan Community in Accra is also the paramount chief of the Obom traditional area, a suburb of Adawso in the Eastern region. Kwatia said his passion to become a health champion compelled him to join HealthKeepers Network (HKN).

Amina Amidu

Amina Amidu is a smart and hardworking young lady who works with the Kayayei (Head Porters) Youth Association in Agbogbloshie, a suburb of Accra. She joined the HealthKeepers Network after learning about it from the leader of the Youth Association.

Photo of HealthKeeper Getrude Kofie speaking to a shopkeeper.

Mrs Gertrude Emelyne Kofie, a Health Keeper based in Ashiyie, a suburb of Adenta in the Greater Accra Region has said that, despite the several challenges confronting her profession as a health worker, she is still determined to continue impacting positively people’s lives.

Francis Amenuve

Francis Amenuve is a HealthKeeper and a subsistence farmer. He attributes his success in getting people to adopt health-promoting practice with his respect for their choices and their privacy.

Photo of Peace Amegadzie holding discussions with drivers at a station in Ashiaman

According to 40-year-old Mrs. Peace Amegadzie, her childhood aspiration was to become a fashion designer, but she has still not regretted switching. As a health worker, she is helping people to improve their health and it has also kept her employed and able to support her family.

Peace Hene, Health Keepers Network

Peace Hene hails from the Volta region of Ghana. She has been a volunteer health worker since 2012 and joined HealthKeepers Network about two years ago.

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.

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