Strategies for Family Planning Service Delivery in Bas Zaire

Abstract

An operations research project measured the impact and cost-effectiveness of two strategies for delivering family planning services in Bas Zaire: Supplying dispensaries and community distributors with contraceptives and at the same time undertaking an extengive outreach program, and supplying these sources but doing no outreach. Before the project began, only about 4-5 percent of urban women and 2-5 percent of rural women aged 15-44 who were living in union were using modern contraceptive methods. Within two years, this proportion had increased to 10-19 percent in four study areas. However, use of traditional methods decreased, suggesting that many women substituted modern methods for traditional ones. Prevalence in the areas that received outreach was only 2-3 percentage points higherthan that in areas that received no outreach. A cost-effectiveness analysis shows that the cost of providing one couple with a month of contraceptive protection was higher in the rural area than in the urban area. In addition, the cost per couple-month of protection was slightly higher when outreach was included.

Evaluation of natural family planning programmes in Liberia and Zambia

“…As the programmes matured, the increasing numbers of autonomous users reduced the costs per CYP over time, and similar trends were reported by Bertrand et al (1986) in Zaire. In this respect, NFP resembles other methods of family planning such as IUDs with high initial costs, but prolonged use-effectiveness with low recurrent or supply costs.…”

“…Costs during learning were high, because NFP involves an intensive teaching phase which demands large amounts of personnel time, but the costs per CYP were much reduced during autonomous use (Table 4). As the programmes matured, the increasing numbers of autonomous users reduced the costs per CYP over time, and similar trends were reported by Bertrand et al (1986) in Zaire. In this respect, NFP resembles other methods of family planning such as IUDs with high initial costs, but prolonged use-effectiveness with low recurrent or supply costs.…”

“…Losses to follow-up do not bias these estimates, because the CYP is based on mean duration of use, including the duration of use prior to loss or discontinuation (Kulkarni & Potter, 1976). The total costs per CYP observed in this study are within the ranges reported for other African NFP studies (Labbok & Shah, 1988;Bertrand et al, 1986), and within the range of costs associated with clinic or community based provision of other family planning methods in Kenya and Nigeria (Huber & Harvey, 1989). Although it is difficult to compare findings between studies, due to differences in the methods used to ascribe programme costs and to measure CYP, these results suggest that NFP can be as cost-effective as other methods of family planning in the African context.…”

Lessons from community-based distribution of family planning in Africa

“…See Musau (1997) Foreit et al 1991), and in Indonesia where the strategy was first developed (Anonymous 1976;Warwick et al 1983). See reviews of projects in Zaire (Bertrand et al 1986 and; Indonesia (Anonymous 1976); Bangladesh (Koblinsky et al 1986); and elsewhere (Ross et al 1987).…”

The Socio‐Cultural Context of Family and Fertility in Sub‐Saharan Africa

“…I t is interesting that some programs have boasted about substitutions of "modern" or "effective" methods for traditional methods such as coitus interruptus and rhythm. without speculating on what would happen when the high technicity oriented pilot project would be replaced by the routine workings of a poorly supplied government service (Bertrand et al. 1986).…”