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Status of CBD in Africa: Evidence from Mali

Status of CBD in Africa: Evidence from Mali. Seydou Doumbia Diouratie Sanogo Ayo Ajayi John W. Townsend. Context of Family Planning in Mali. Population: 11.3 million, nearly half below 15 years of age TFR of 6.7 and 3% growth rate

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Status of CBD in Africa: Evidence from Mali

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  1. Status of CBD in Africa: Evidence from Mali Seydou Doumbia Diouratie Sanogo Ayo Ajayi John W. Townsend

  2. Context of Family Planning in Mali • Population: 11.3 million, nearly half below 15 years of age • TFR of 6.7 and 3% growth rate • With 70% of population rural, access to basic health services is limited ( 20%) • HIV adult infection - 1.7%

  3. Milestones in the National Program • 1980 Founding of Family Health Division • 1989 First CBD effort in 54 villages • 1991 Explicit population policy • 1994 Established National Family Planning Program – DRH • 2003 Strategic Development Plan

  4. Contraceptive Prevalence in Mali (DHS)

  5. Reasons for Non-Use of Family Planning Among Married Women(DHS, 1996)

  6. Results of CBD Pilot 1989-92

  7. CBD Programs in Mali • Public CBD program since 1990, with 44 percent of all CBD agents • 13 NGOs support CBD networks • Public supervisors are nurses, while NGO supervisors more diverse • Ratio of supervisors to agents - 1:5 to 1:70 • Weak public-private collaboration

  8. Roles of CBD Agent • Inform and educate rural communities for behavior change • Sale (75%) and/or distribute (25%) contraceptive methods • Refer clients to health centers • Coordinate with Community Health Associations (ASACO)

  9. Geographic Coverage of CBD by Region

  10. Profile of CBD Agents • More than 50% of CBD agents are men • Median age for both men and women is 35 or above • Most are married, half of women in polygamous relationships, and have basic education (1st and 2nd cycle) • Principal income from agriculture, although women involved in commerce

  11. Recommendations for Improving CBD Program • Expand effective coverage of national program • Reinforce link between agents and ASACO and other community groups • Reinforce supervision of agents • Reinforce logistic supply for CBD agents

  12. Further Recommendations • Experiment with alternative strategies for motivation • Test innovative services for men and youth • Experiment with dual protection strategy • Evaluate impact of child survival activities in CBD program

  13. Looking to the Future • Disseminate findings to key audiences • Review priority tasks and information used for management • Strengthen related operational policies and financing • Improve quality in existing care networks and related commercial services

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