Community-based distribution serves unmet needs

July 20, 1999

PACARA SULLICANI, Peru — By reaching out into rural communities and isolated city neighborhoods, community-based distribution (CBD) programs can serve unmet needs for contraception. Where contraceptive prevalence is very low, community programs can also generate demand for family planning.

While there are many variations, community-based distribution programs generally seek to take contraceptive methods and family planning information to people where they live, rather than requiring people to visit clinics or other locations for these services. The approach often involves community members who are trained to become family planning workers.

That community services can increase contraceptive use has been observed throughout the world, experts say in the current issue of Network, the quarterly bulletin of Family Health International. Contraceptive use is enhanced further when CBD workers can offer clients a wide variety of methods, either directly or by referral.

In Peru, for example, hundreds of community promoters of contraception work in communities near Puno through a project of CARE-Peru and the Peruvian Ministry of Health (MINSA). This eight-year-old project, called the Multisectoral Project of Population and Reproductive Health (PMP), serves approximately 300,000 families throughout the country. Community promoters can distribute condoms, vaginal tablets and oral contraceptives. For longer-acting or permanent methods, they make referrals to a MINSA health post, center or hospital.

"The economy of this area makes it very hard for us to raise large families," says Felix Montufa, a farmer and one of the volunteer family planning promoters, who lives in the isolated community of Pacara Sullicani in the highlands in southeastern Peru.

Reaching the nearest town with basic health services from this farming community takes at least two hours over difficult terrain, when weather conditions are good. Few of the approximately 200 residents who live there have time to leave their farm work, or even wish to travel to the larger town where their language, Aymara, is not widely understood.

Standing before the dried brown mud and thatch room that he built to provide family planning consultations, Montufa explains how he was enlisted to do family planning work, which occupies about two days of his time each week. "I have been providing other community services since 1987 and I was chosen by the community leaders to be a reproductive health promoter," he says. "I do this now because I know that if couples have six or eight or 10 children, it is not good for my community. I like to know that I’m doing something good for my people."

In other locations, larger PMP projects also provide maternal health and sexually transmitted disease prevention, in addition to family planning. "The goal has been to get communities involved," says Dr. Irma Ramos of CARE-Peru, PMP project coordinator.

Also in this issue of Network are profiles of CBD programs that serve city clients in Juliaca, Peru, and programs serving Zimbabwe and Bangladesh. Ways to motivate CBD workers. comparing program costs, offering CBD with other services and the influence of gender issues on CBD programs are examined in other articles.