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Enhancing Family Planning in Mali through Community-Based Distribution Agents

Explore the status of CBD in Mali, the role of agents, and recommendations for improving the national program to broaden its reach and impact on family planning. Discover key milestones, coverage, profiles of agents, and future directions.

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Enhancing Family Planning in Mali through Community-Based Distribution Agents

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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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