Community-based Programmes: a Strategy for Improving Access and Quality. Ian Askew FRONTIERS in Reproductive Health Population Council. What Have We Learned From 20 Years of CBD in West Africa?. CBD Can Generate Interest in Child Spacing and FP Use.
FRONTIERS in Reproductive Health
Public and Private Sector: and Quality
NGO, church-based, employment-based
Part-time – voluntary or allowance
Full-time – salaried employees
Home visits, depot/post
No single model – each developed to fit the situationWhat Types of “CBD” Have Been Tried?
Fertility preferences still high and Quality
Interest in using FP to space or limit births still low
Changing these social norms requires education and discussion at individual, family and community level
Clinic-based services cannot easily stimulate or facilitate such social interactionsWhy Is CBDa Repositioning Strategy for FP?
Providing contraceptives through clinics limits their physical, financial and social access
Clinics cannot effectively reach men with FP messages and condoms
CBD facilitates continuation of use
CBD can offer FP integrated within a range of basic health information and services (malaria, ORT, iron tablets, STI information, etc.)Why Is CBDa Repositioning Strategy for FP?
Currently offering information, condoms, pills, spermicides, NFP, and referral for clinical methods
Can injectables be offered?
Can emergency contraception be offered?
Can IUCD be offered?
Dual protection messages can be communicated – but to what effect?Challenges – Can CBD Provide More FP Services?
Can verbal risk screening and referral be added?
Can STI treatment for males be added?
Can CBD link with VCT, ART and home-based care?
Information about pregnancy and child nutrition?
Birth planning and support for assisted deliveries?Challenges – HIV, Safe Motherhood and Child Survival Services?
Transition from pilot project to routine programme critical – but how?
Diversification of programme role and income sources (NGOs: Ghana; Zimbabwe)
Planned phasing: (MOH: Ghana)
Pilot model, then experiment to test effectiveness (Navrongo)
Sustain, and demonstrate replication (Nkwanta)
Gradual nationwide expansion (CHPS)
Revitalise existing government community programmes (Senegal)Major Challenge– Ensuring Sustainability
Commitment to a large-scale, routine CBD programme critical – but how?
Belief in cost-effectiveness of strategy
Willingness to engage community-level cadre as standard staffing component
Pilot test model first to identify how it works
Plan for going to scale from the beginning:
Immediately sustain successful pilot model in project sites (and expand to district level)
Document successful configuration and pilot its replication in limited additional districts
Develop systems to enable expansion nationwideCritical Elements in Sustaining Community-based Programmes
National leadership….with district ownership critical – but how?
Reinvigorate (and reconfigure) existing community-level cadres rather than develop new cadre
Do not use volunteers in isolation from an employed cadre
Offer a range of related and integrated services
Include possibility of cost- and profit-sharing for commodities
Move from project-funding to line-item budgeting as soon as possibleProgrammatic Recommendations